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Predicting outcome from hypoxic-ischemic coma
ABSTRACTS
standard CPR because of limited paramedic manpower necessary to continue IAC-CPR. Twenty-eight percent of the IAC-CPR group and 31% of the standard CPR group had a rhythm and pulse on hospital arrival. The frequency of emesis after intubation was not significantly different between the two groups. There were no known visceral injuries although only six autopsies were performed. The authors conclude that IAC-CPR does not improve cardiac resuscitation rates in the prehospital setting. [Editor's n o t e : Unfortunately ultimate survival and permanent neurologic sequelae were not reported in these two Study groups. This is the bottom line in determining the efficacy of IAC-CPR over other modalities of CPR.] John Neufeld, MD
PEDIATRIC INJURY, NONCRASH MOTOR VEHICLE ACCIDENTS
etiology. The etiology of the coma was cardiac arrest (71%), respiratory failure (11%), and other causes (18%). The median age was 61 years. The longer the duration of coma the poorer fhe prognosis. Thirteen percent of patients regained independent function during the first year. Specific neurologic signs were related to recovery. Initially incomprehensible speech was a most favorable sign. At one day from onset of coma each of the following signs was associated with a 50% chance of independent recovery: confused or inappropriate speech, orienting spontaneous eye movements, and intact oculocephalic or oculovestibular responses. Of the 27 patients initially identified with pupillary light reflexes, extensor or better m o t o r responses, spontaneous eye movements and roving or conjugate gaze, 11 (41%) regained independent function. Fifty-two patients lacked pupillary responses initially; none recovered independence, and only three became conscious. Ninety-three patients lacked spontaneous eye movement and roving or conjugate gaze; only one became independent.
Noncrash motor vehicle accidents
Sarah Kuhn Scott, MD
Agran PF, Dunkle DL, Winn D Am J Dis Child 139:304-306 Mar 1985 GLASGOW COMA SCALE; HEAD TRAUMA
A multihospital monitoring system provided information for prospective analysis of injuries sustained by children impacting automobile interiors in noncrash motor vehicle accidents during a 39-month period. Of the 1,300 children involved in accidents, 154 (12%) were injured in noncrash accidents. Motor vehicle maneuvers causing injury included sudden stops, acceleration, turns, and swerves. Children up to age 15 were studied, with ages 1 through 4 the most commonly injured (54%). These injuries typically were unrestrained front seat passengers involved in sudden stops. Injuries generally were m i n o r (89%); 11%, however, did sustain moderate to severe injury, and 2% were hospitalized. Twenty-five percent sustained lacerations. These children were more often located in the back seat. Among the injured children, only 17% were restrained. Under age 4, all those injured while in car restraint seats were improperly restrained. None of the children under age 4 who were wearing only lap belts were prevented from hitting the car interior. Most injuries were considered preventable by appropriate restraint use.
Sarah Kuhn Scott, MD COMA, HYPOXIC-ISCHEMIC
Predicting outcome from hypoxic-ischemic coma Levy DE, Caronna JJ, Singer BH, et al JAMA 253:1420-1426 Mar 1985
A prospective study was performed on 210 patients who had cerebral h y p o x i c - i s c h e m i c c o m a of n o n t r a u m a t i c 130/705
E x t r a c r a n i a l insults and o u t c o m e in p a t i e n t s w i t h a c u t e h e a d injury R e l a t i o n s h i p to t h e G l a s g o w c o m a s c a l e Kohi YM, Mendelow AD, Teasdale GM, et al Injury 16:25-29 Sep 1984
This study was devised to assess the prognostic interactions of hypoxia, hypotension , and Glasgow coma scale (GCS) in acute head-injured patients. During a six-month period in 1981, 67 victims of acute head trauma admitted to a neurosurgical intensive care unit in Scotland were categorized according to hypoxia (PaO~ < 65 m m Hg, or requiring assisted mechanical ventilation), hypotension (systemic arterial pressure < 90 m m Hg), and level of consciousness (by the GCS). Six months later outcome was assessed using the Glasgow outcome scale and classified as unfavorable (dead or vegetative) or favorable (severe disability to good recovery). Overall 75% of patients had GCSs of less than 8; 44% had unfavorable outcomes; 36% had hypoxic insults; and 12% were hypotensive. Significant correlations were as follows: 1) 71% of patients with hypoxia, 88% with hypotension, and 100% with both had unfavorable outcomes; 75% of hypotensive patients were also hypoxic; 2) all patients with a GCS of 8 or more had favorable outcomes; only three of 17 patients in this category had either hypoxia or hypotension; 3) the presence of hypoxia, hypotension, or both increased unfavorable outcomes from 20% to 60% in patients with a GCS of 6 to 7, and from 53% to 83% in those with a GCS of 3 to 5. This study confirms the effectiveness of the GCS in predicting outcome after acute head injury, and it proposes that the extracranial insults of hypoxia and hypotension be used as additional prognostic
Annals of EmergencyMedicine
14:7 July 1985
standard CPR because of limited paramedic manpower necessary to continue IAC-CPR. Twenty-eight percent of the IAC-CPR group and 31% of the standard CPR group had a rhythm and pulse on hospital arrival. The frequency of emesis after intubation was not significantly different between the two groups. There were no known visceral injuries although only six autopsies were performed. The authors conclude that IAC-CPR does not improve cardiac resuscitation rates in the prehospital setting. [Editor's n o t e : Unfortunately ultimate survival and permanent neurologic sequelae were not reported in these two Study groups. This is the bottom line in determining the efficacy of IAC-CPR over other modalities of CPR.] John Neufeld, MD
PEDIATRIC INJURY, NONCRASH MOTOR VEHICLE ACCIDENTS
etiology. The etiology of the coma was cardiac arrest (71%), respiratory failure (11%), and other causes (18%). The median age was 61 years. The longer the duration of coma the poorer fhe prognosis. Thirteen percent of patients regained independent function during the first year. Specific neurologic signs were related to recovery. Initially incomprehensible speech was a most favorable sign. At one day from onset of coma each of the following signs was associated with a 50% chance of independent recovery: confused or inappropriate speech, orienting spontaneous eye movements, and intact oculocephalic or oculovestibular responses. Of the 27 patients initially identified with pupillary light reflexes, extensor or better m o t o r responses, spontaneous eye movements and roving or conjugate gaze, 11 (41%) regained independent function. Fifty-two patients lacked pupillary responses initially; none recovered independence, and only three became conscious. Ninety-three patients lacked spontaneous eye movement and roving or conjugate gaze; only one became independent.
Noncrash motor vehicle accidents
Sarah Kuhn Scott, MD
Agran PF, Dunkle DL, Winn D Am J Dis Child 139:304-306 Mar 1985 GLASGOW COMA SCALE; HEAD TRAUMA
A multihospital monitoring system provided information for prospective analysis of injuries sustained by children impacting automobile interiors in noncrash motor vehicle accidents during a 39-month period. Of the 1,300 children involved in accidents, 154 (12%) were injured in noncrash accidents. Motor vehicle maneuvers causing injury included sudden stops, acceleration, turns, and swerves. Children up to age 15 were studied, with ages 1 through 4 the most commonly injured (54%). These injuries typically were unrestrained front seat passengers involved in sudden stops. Injuries generally were m i n o r (89%); 11%, however, did sustain moderate to severe injury, and 2% were hospitalized. Twenty-five percent sustained lacerations. These children were more often located in the back seat. Among the injured children, only 17% were restrained. Under age 4, all those injured while in car restraint seats were improperly restrained. None of the children under age 4 who were wearing only lap belts were prevented from hitting the car interior. Most injuries were considered preventable by appropriate restraint use.
Sarah Kuhn Scott, MD COMA, HYPOXIC-ISCHEMIC
Predicting outcome from hypoxic-ischemic coma Levy DE, Caronna JJ, Singer BH, et al JAMA 253:1420-1426 Mar 1985
A prospective study was performed on 210 patients who had cerebral h y p o x i c - i s c h e m i c c o m a of n o n t r a u m a t i c 130/705
E x t r a c r a n i a l insults and o u t c o m e in p a t i e n t s w i t h a c u t e h e a d injury R e l a t i o n s h i p to t h e G l a s g o w c o m a s c a l e Kohi YM, Mendelow AD, Teasdale GM, et al Injury 16:25-29 Sep 1984
This study was devised to assess the prognostic interactions of hypoxia, hypotension , and Glasgow coma scale (GCS) in acute head-injured patients. During a six-month period in 1981, 67 victims of acute head trauma admitted to a neurosurgical intensive care unit in Scotland were categorized according to hypoxia (PaO~ < 65 m m Hg, or requiring assisted mechanical ventilation), hypotension (systemic arterial pressure < 90 m m Hg), and level of consciousness (by the GCS). Six months later outcome was assessed using the Glasgow outcome scale and classified as unfavorable (dead or vegetative) or favorable (severe disability to good recovery). Overall 75% of patients had GCSs of less than 8; 44% had unfavorable outcomes; 36% had hypoxic insults; and 12% were hypotensive. Significant correlations were as follows: 1) 71% of patients with hypoxia, 88% with hypotension, and 100% with both had unfavorable outcomes; 75% of hypotensive patients were also hypoxic; 2) all patients with a GCS of 8 or more had favorable outcomes; only three of 17 patients in this category had either hypoxia or hypotension; 3) the presence of hypoxia, hypotension, or both increased unfavorable outcomes from 20% to 60% in patients with a GCS of 6 to 7, and from 53% to 83% in those with a GCS of 3 to 5. This study confirms the effectiveness of the GCS in predicting outcome after acute head injury, and it proposes that the extracranial insults of hypoxia and hypotension be used as additional prognostic
Annals of EmergencyMedicine
14:7 July 1985