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PubMed · 3467537

Is it possible to define a general "conscious level"?

Abstract

The difficulties in defining a general conscious level are discussed as exemplified by Glasgow Coma Scale and Reaction Level Scale, a new scale recommended by Swedish neurosurgeons. Precise definitions of stimuli and of responses are needed since several studies have shown ambiguity of assessment within the same patient. Some of the difficulties arising from summing up and grouping levels of the Glasgow Coma Scores are discussed and as a consequence a new level for defining coma with a better reliability is proposed. We also briefly discuss the difficulty when to stop assessing conscious level.

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BibTeXRIS

J E Starmark, S Lindgren. 1986. Is it possible to define a general "conscious level"?. https://pubmed.ncbi.nlm.nih.gov/3467537/

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Predicting coma and other low responsive patients outcome using event-related brain potentials: a meta-analysis.

OBJECTIVE: A meta-analysis was performed to estimate the predictive power (odd ratio, OR) for awakening of auditory event-related potential (ERP) components in low responsive patients with stroke or hemorrhage, trauma, anoxic, post-operative, and metabolic encephalopathy etiologies. METHODS: We reviewed MEDLINE and analyzed citations for retrieved articles. Logistic regressions were applied on patient samples (Glasgow Coma Scale <12) across and for separate etiologies. RESULTS: For stroke and hemorrhage the ORs with 95% confidence intervals were: 2.05 [1.12-3.75] (N100), 4.47 [1.92-10.44] (MMN), 10.29 [2.00-52.79] (P300), for trauma: 1.63 [0.70-3.80] (N100), 4.72 [1.35-16.44] (MMN), 12.89 [4.82-34.43] (P300), anoxic: 8.03 [2.83-22.75] (N100), 15.50 [4.27-56.26] (MMN), 5.93 [2.38-14.77] (P300), post-operative: 10.66 [1.98-57.50] (N100), metabolic encephalopathy: 2.12 [0.34-13.13] (N100), 3.60 [0.28-46.36] (MMN), 7.71 [0.75-79.77] (P300), and all etiologies: 2.85 [1.91-4.27] (N100), 6.53 [3.55-12.01] (MMN), and 8.79 [4.88-15.83] (P300). Based on six N100 studies (N=548 patients), five MMN studies (N=470), and six P300 studies (N=313), the N100, MMN, or P300, when present, significantly predicted awakening, P300 and MMN being significantly better predictors than N100. CONCLUSIONS: The MMN and P300 appear to be reliable predictors of awakening. SIGNIFICANCE: The prognostic assessment of low responsive patients with auditory ERP should take into account both MMN and P300.

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