Neuroanatomical predictors of awakening in acutely comatose patients

Robert G. Kowalski, Manuel M. Buitrago, Josh Duckworth, Zachary D. Chonka, Hans Adrian Puttgen, Robert David Stevens, Romergryko Geocadin

Research output: Contribution to journalArticle

Abstract

Objective Lateral brain displacement has been associated with loss of consciousness and poor outcome in a range of acute neurologic disorders. We studied the association between lateral brain displacement and awakening from acute coma. Methods This prospective observational study included all new onset coma patients admitted to the Neurosciences Critical Care Unit (NCCU) over 12 consecutive months. Head computed tomography (CT) scans were analyzed independently at coma onset, after awakening, and at follow-up. Primary outcome measure was awakening, defined as the ability to follow commands before hospital discharge. Secondary outcome measures were discharge Glasgow Coma Scale (GCS), modified Rankin Scale, Glasgow Outcome Scale, and hospital and NCCU lengths of stay. Results Of the 85 patients studied, the mean age was 58 ± 16 years, 51% were female, and 78% had cerebrovascular etiology of coma. Fifty-one percent of patients had midline shift on head CT at coma onset and 43 (51%) patients awakened. In a multivariate analysis, independent predictors of awakening were younger age (odds ratio [OR] = 1.039, 95% confidence interval [CI] = 1.002-1.079, p = 0.040), higher GCS score at coma onset (OR = 1.455, 95% CI = 1.157-1.831, p = 0.001), nontraumatic coma etiology (OR = 4.464, 95% CI = 1.011-19.608, p = 0.048), lesser pineal shift on follow-up CT (OR = 1.316, 95% CI = 1.073-1.615, p = 0.009), and reduction or no increase in pineal shift on follow-up CT (OR = 11.628, 95% CI = 2.207-62.500, p = 0.004). Interpretation Reversal and/or limitation of lateral brain displacement are associated with acute awakening in comatose patients. These findings suggest objective parameters to guide prognosis and treatment in patients with acute onset of coma. Ann Neurol 2015;77:804-816

Original languageEnglish (US)
Pages (from-to)804-816
Number of pages13
JournalAnnals of Neurology
Volume77
Issue number5
DOIs
StatePublished - May 1 2015

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Coma
Odds Ratio
Confidence Intervals
Tomography
Glasgow Coma Scale
Critical Care
Neurosciences
Brain
Head
Outcome Assessment (Health Care)
Glasgow Outcome Scale
Unconsciousness
Nervous System Diseases
Observational Studies
Length of Stay
Multivariate Analysis
Prospective Studies

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Medicine(all)

Cite this

Kowalski, R. G., Buitrago, M. M., Duckworth, J., Chonka, Z. D., Puttgen, H. A., Stevens, R. D., & Geocadin, R. (2015). Neuroanatomical predictors of awakening in acutely comatose patients. Annals of Neurology, 77(5), 804-816. https://doi.org/10.1002/ana.24381

Neuroanatomical predictors of awakening in acutely comatose patients. / Kowalski, Robert G.; Buitrago, Manuel M.; Duckworth, Josh; Chonka, Zachary D.; Puttgen, Hans Adrian; Stevens, Robert David; Geocadin, Romergryko.

In: Annals of Neurology, Vol. 77, No. 5, 01.05.2015, p. 804-816.

Research output: Contribution to journalArticle

Kowalski, RG, Buitrago, MM, Duckworth, J, Chonka, ZD, Puttgen, HA, Stevens, RD & Geocadin, R 2015, 'Neuroanatomical predictors of awakening in acutely comatose patients', Annals of Neurology, vol. 77, no. 5, pp. 804-816. https://doi.org/10.1002/ana.24381
Kowalski RG, Buitrago MM, Duckworth J, Chonka ZD, Puttgen HA, Stevens RD et al. Neuroanatomical predictors of awakening in acutely comatose patients. Annals of Neurology. 2015 May 1;77(5):804-816. https://doi.org/10.1002/ana.24381
Kowalski, Robert G. ; Buitrago, Manuel M. ; Duckworth, Josh ; Chonka, Zachary D. ; Puttgen, Hans Adrian ; Stevens, Robert David ; Geocadin, Romergryko. / Neuroanatomical predictors of awakening in acutely comatose patients. In: Annals of Neurology. 2015 ; Vol. 77, No. 5. pp. 804-816.
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abstract = "Objective Lateral brain displacement has been associated with loss of consciousness and poor outcome in a range of acute neurologic disorders. We studied the association between lateral brain displacement and awakening from acute coma. Methods This prospective observational study included all new onset coma patients admitted to the Neurosciences Critical Care Unit (NCCU) over 12 consecutive months. Head computed tomography (CT) scans were analyzed independently at coma onset, after awakening, and at follow-up. Primary outcome measure was awakening, defined as the ability to follow commands before hospital discharge. Secondary outcome measures were discharge Glasgow Coma Scale (GCS), modified Rankin Scale, Glasgow Outcome Scale, and hospital and NCCU lengths of stay. Results Of the 85 patients studied, the mean age was 58 ± 16 years, 51{\%} were female, and 78{\%} had cerebrovascular etiology of coma. Fifty-one percent of patients had midline shift on head CT at coma onset and 43 (51{\%}) patients awakened. In a multivariate analysis, independent predictors of awakening were younger age (odds ratio [OR] = 1.039, 95{\%} confidence interval [CI] = 1.002-1.079, p = 0.040), higher GCS score at coma onset (OR = 1.455, 95{\%} CI = 1.157-1.831, p = 0.001), nontraumatic coma etiology (OR = 4.464, 95{\%} CI = 1.011-19.608, p = 0.048), lesser pineal shift on follow-up CT (OR = 1.316, 95{\%} CI = 1.073-1.615, p = 0.009), and reduction or no increase in pineal shift on follow-up CT (OR = 11.628, 95{\%} CI = 2.207-62.500, p = 0.004). Interpretation Reversal and/or limitation of lateral brain displacement are associated with acute awakening in comatose patients. These findings suggest objective parameters to guide prognosis and treatment in patients with acute onset of coma. Ann Neurol 2015;77:804-816",
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AB - Objective Lateral brain displacement has been associated with loss of consciousness and poor outcome in a range of acute neurologic disorders. We studied the association between lateral brain displacement and awakening from acute coma. Methods This prospective observational study included all new onset coma patients admitted to the Neurosciences Critical Care Unit (NCCU) over 12 consecutive months. Head computed tomography (CT) scans were analyzed independently at coma onset, after awakening, and at follow-up. Primary outcome measure was awakening, defined as the ability to follow commands before hospital discharge. Secondary outcome measures were discharge Glasgow Coma Scale (GCS), modified Rankin Scale, Glasgow Outcome Scale, and hospital and NCCU lengths of stay. Results Of the 85 patients studied, the mean age was 58 ± 16 years, 51% were female, and 78% had cerebrovascular etiology of coma. Fifty-one percent of patients had midline shift on head CT at coma onset and 43 (51%) patients awakened. In a multivariate analysis, independent predictors of awakening were younger age (odds ratio [OR] = 1.039, 95% confidence interval [CI] = 1.002-1.079, p = 0.040), higher GCS score at coma onset (OR = 1.455, 95% CI = 1.157-1.831, p = 0.001), nontraumatic coma etiology (OR = 4.464, 95% CI = 1.011-19.608, p = 0.048), lesser pineal shift on follow-up CT (OR = 1.316, 95% CI = 1.073-1.615, p = 0.009), and reduction or no increase in pineal shift on follow-up CT (OR = 11.628, 95% CI = 2.207-62.500, p = 0.004). Interpretation Reversal and/or limitation of lateral brain displacement are associated with acute awakening in comatose patients. These findings suggest objective parameters to guide prognosis and treatment in patients with acute onset of coma. Ann Neurol 2015;77:804-816

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