Prognostic value of initial Glasgow Coma Score in comatosed patients on medical floor

Abstract

Objective: An open non-randomized prospective observational study of comatosed patients was conducted to correlate initial Glasgow Coma Score (GCS) with the outcome in patients having medical coma at Mayo Hospital, Lahore between January 2002 to September 2003. Methods: A total of 273 patients were followed throughout their hospital stay to determine the outcome after the current episode of coma. A thorough history and examination was obtained for each case. The 3 category Glasgow Coma Score was recorded as an indication of the degree of unconsciousness. One of three possible outcome categories was established, recovery (discharge), death, and referral or self discharge (by attendants) against medical advice. Results: The outcome of 248 patients (90.84%) was established i.e. 152 (61.29%) were discharged after recovery and 96 (38.71%) died. The remaining 25 (09.16%) patients were lost to follow up. Four subcategories of the Glasgow Coma Score were made, at 3-point intervals. In the lowest score category ( score 3-5) there was 59.67% mortality and only 30.66% patients were successfully treated and discharged. In the category of GCS 6-8, 30.91% died and 60% were discharged, while in the 9-11 category, 26.47% died and 66.18% were discharged. In the highest score category (12-15), 27.27% deaths occurred, probably related to the severity of main event, and 62.50% were discharged. Conclusion: The depth of coma as reflected by the initial GCS can reliably be used to predict the outcome in comatosed patients.