Prognosis in Nontraumatic Coma

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Abstract
Serial neurologic examinations were conducted on 500 patients in nontraumatic coma to identify factors predicting recovery. Overall, 81 patients (16%) led an independent life at some point within the 1st year; the remainder either died without recovery from coma (61%), never improved beyond the vegetative state (12%) or regained consciousness, but remained dependent on others for daily activities (11%). Functional recovery did not depend on age but was to some degree related to the cause of coma (subarachnoid hemorrhage and other cerebrovascular disease having the worst recovery; hypoxia-ischemia, intermediate; and hepatic and miscellaneous causes, best) and especially to early clinical signs of brain dysfunction. Even within hours of the onset of coma, only 1 of 120 patients lacking 2 of corneal, pupillary and oculovestibular responses ever regained independent function. Clinical features of comatose patients that appear within the 1st week and are important for predicting recovery and designing future therapeutic trials are identified.
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