Monday, July 25, 2005
Neurologic outcome in coma
I was Googling the difference in defining "irreversibility" w/r/t people in persistent vegetative states due to trauma vs anoxic brain injuries when I stumbled upon a very nice review of predicting neurologic outcome in people in comas from the J Neurol Neurosurg Psychiatry (2001). Free full text appears to be available. It summarizes prognosis based on etiology of coma, length of coma, & clinical signs. There's nothing new here, but the article is a tidy summary that would be handy for quick reference.
As an aside, my biggest frustration in researching this topic is the reporting of outcomes. Most of the papers I've looked at have presented outcome dually (Bad being death/persistent coma/pvs/severe neurologic impairment-disability; Good being full recovery or moderate disability). This is a problem because for some families that are struggling with goals of care for a loved one in a coma there is a big difference between a PVS and severe disability. For some, severe disability (in which the patient would need lifelong care & would have some cognitive impairment but will still be able to interact/communicate on some level) would be acceptable/compatible with the patient's wishes, whereas PVS would not. Most of the literature doesn't really differentiate between these two and isn't helpful for these situations.
