This article, published in Practical Neurology in 2020, discusses the challenges neurologists face when predicting outcomes for comatose patients. Key points include:
## Coma Definition and Assessment
- Coma is defined as a state of being unaware and not awake
- Most patients in coma recover and become more awake over time
- Neuroimaging and EEG can help assess coma but are rarely definitive
## Principles of Prognostication
1. Examine the patient thoroughly
2. Review neuroimaging carefully
3. Evaluate laboratory and ancillary tests
4. Consider confounding factors
5. Acknowledge uncertainties
6. Factor in the patient's wishes and comorbidities
7. Refrain from predictions if too uncertain
8. Proceed with brain death examination if applicable
9. Communicate candidly with family
10. Develop a care plan based on prognosis
## Prognosis by Disease Categories
- Traumatic brain injury: Outcome is difficult to predict, especially in younger patients
- Age is the most important determinant of outcome
- Certain imaging findings, like primary brainstem lesions, indicate poor prognosis
- Sustained increased intracranial pressure negatively impacts outcomes
The article emphasizes the complexity of prognostication in comatose patients and the need for careful, comprehensive assessment before making predictions about outcomes.
Full Article: Predicting the outcome of a comatose patient at the bedside | Practical Neurology
