Identification of Comatose Patients at High Risk for Death or Severe Disability

Mary Beth Hamel, Roger B. Davis, Russell S. Phillips, Lee Goldman, Joan Teno, Joanne Lynn, Frank E. Harrell, Robert Califf, Peter Kussin, Alfred F. Connors, Paul Bellamy, Humberto Vidaillet

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

To develop and validate a simple prognostic scoring system to identify patients in nontraumatic coma at high risk for poor outcomes using data available early in the hospital course. —Prospective cohort study. —Five geographically diverse academic medical centers. —A total of 596 patients in nontraumatic coma enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments(SUPPORT), including 247 in the model derivation set and 349 in the model validation set. —Death and severe disability by 2 months. —For the 596 patients studied(median age, 67 years; 52% female), the primary cause of coma was cardiac arrest in 31% and cerebral infarction or intracerebral hemorrhage in 36%. At 2 months 69% had died, 20% had survived with known severe disability, 8% were known to have survived without severe disability, and 3% survived with unknown functional status. Five clinical variables available on day 3 after enrollment were associated independently with 2-month mortality: abnormal brain stem response(adjusted odds ratio [OR]=3.2; 95% confidence interval [CI], 1.3 to 8.1), absent verbal response(OR=4.6; 95% CI, 1.8 to 11.7), absent withdrawal response to pain(OR=4.3; 95% CI, 1.7 to 10.8), creatinine level greater than or equal to 132.6 μmol/L(1.5 mg/dL)(OR=4.5; 95% CI, 1.8 to 11.0), and age of 70 years or older(OR=5.1; 95% CI, 2.2 to 12.2). Mortality at 2 months for patients with four or five of these risk factors was 97%(58/60; 95% CI, 88% to 100%) in the validation set. Brain stem and motor responses best predicted death or severe disability by 2 months. For patients with either an abnormal brain stem response or absent motor response to pain, the rate of death or severe disability at 2 months was 96%(185/193; 95% CI, 92% to 98%) in the validation set. —Five readily available clinical variables identify a large subgroup of patients in nontraumatic coma at high risk for poor outcomes. This risk stratification approach offers physicians, patients, and patients’ families information that may prove useful in patient care decisions and resource allocation.(JAMA 1995;273:1842-1848).

Original languageEnglish (US)
Pages (from-to)1842-1848
Number of pages7
JournalJAMA: The Journal of the American Medical Association
Volume273
Issue number23
DOIs
StatePublished - Jun 21 1995
Externally publishedYes

Fingerprint

Coma
Confidence Intervals
Odds Ratio
Brain Stem
Cerebral Hemorrhage
Mortality
Pain
Resource Allocation
Cerebral Infarction
Heart Arrest
Creatinine
Patient Care
Cohort Studies
Prospective Studies
Physicians

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Identification of Comatose Patients at High Risk for Death or Severe Disability. / Hamel, Mary Beth; Davis, Roger B.; Phillips, Russell S.; Goldman, Lee; Teno, Joan; Lynn, Joanne; Harrell, Frank E.; Califf, Robert; Kussin, Peter; Connors, Alfred F.; Bellamy, Paul; Vidaillet, Humberto.

In: JAMA: The Journal of the American Medical Association, Vol. 273, No. 23, 21.06.1995, p. 1842-1848.

Research output: Contribution to journalArticle

Hamel, MB, Davis, RB, Phillips, RS, Goldman, L, Teno, J, Lynn, J, Harrell, FE, Califf, R, Kussin, P, Connors, AF, Bellamy, P & Vidaillet, H 1995, 'Identification of Comatose Patients at High Risk for Death or Severe Disability', JAMA: The Journal of the American Medical Association, vol. 273, no. 23, pp. 1842-1848. https://doi.org/10.1001/jama.1995.03520470050031
Hamel, Mary Beth ; Davis, Roger B. ; Phillips, Russell S. ; Goldman, Lee ; Teno, Joan ; Lynn, Joanne ; Harrell, Frank E. ; Califf, Robert ; Kussin, Peter ; Connors, Alfred F. ; Bellamy, Paul ; Vidaillet, Humberto. / Identification of Comatose Patients at High Risk for Death or Severe Disability. In: JAMA: The Journal of the American Medical Association. 1995 ; Vol. 273, No. 23. pp. 1842-1848.
@article{bbe37ee35aff416e88bae24579da59a3,
title = "Identification of Comatose Patients at High Risk for Death or Severe Disability",
abstract = "To develop and validate a simple prognostic scoring system to identify patients in nontraumatic coma at high risk for poor outcomes using data available early in the hospital course. —Prospective cohort study. —Five geographically diverse academic medical centers. —A total of 596 patients in nontraumatic coma enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments(SUPPORT), including 247 in the model derivation set and 349 in the model validation set. —Death and severe disability by 2 months. —For the 596 patients studied(median age, 67 years; 52{\%} female), the primary cause of coma was cardiac arrest in 31{\%} and cerebral infarction or intracerebral hemorrhage in 36{\%}. At 2 months 69{\%} had died, 20{\%} had survived with known severe disability, 8{\%} were known to have survived without severe disability, and 3{\%} survived with unknown functional status. Five clinical variables available on day 3 after enrollment were associated independently with 2-month mortality: abnormal brain stem response(adjusted odds ratio [OR]=3.2; 95{\%} confidence interval [CI], 1.3 to 8.1), absent verbal response(OR=4.6; 95{\%} CI, 1.8 to 11.7), absent withdrawal response to pain(OR=4.3; 95{\%} CI, 1.7 to 10.8), creatinine level greater than or equal to 132.6 μmol/L(1.5 mg/dL)(OR=4.5; 95{\%} CI, 1.8 to 11.0), and age of 70 years or older(OR=5.1; 95{\%} CI, 2.2 to 12.2). Mortality at 2 months for patients with four or five of these risk factors was 97{\%}(58/60; 95{\%} CI, 88{\%} to 100{\%}) in the validation set. Brain stem and motor responses best predicted death or severe disability by 2 months. For patients with either an abnormal brain stem response or absent motor response to pain, the rate of death or severe disability at 2 months was 96{\%}(185/193; 95{\%} CI, 92{\%} to 98{\%}) in the validation set. —Five readily available clinical variables identify a large subgroup of patients in nontraumatic coma at high risk for poor outcomes. This risk stratification approach offers physicians, patients, and patients’ families information that may prove useful in patient care decisions and resource allocation.(JAMA 1995;273:1842-1848).",
author = "Hamel, {Mary Beth} and Davis, {Roger B.} and Phillips, {Russell S.} and Lee Goldman and Joan Teno and Joanne Lynn and Harrell, {Frank E.} and Robert Califf and Peter Kussin and Connors, {Alfred F.} and Paul Bellamy and Humberto Vidaillet",
year = "1995",
month = "6",
day = "21",
doi = "10.1001/jama.1995.03520470050031",
language = "English (US)",
volume = "273",
pages = "1842--1848",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "23",

}

TY - JOUR

T1 - Identification of Comatose Patients at High Risk for Death or Severe Disability

AU - Hamel, Mary Beth

AU - Davis, Roger B.

AU - Phillips, Russell S.

AU - Goldman, Lee

AU - Teno, Joan

AU - Lynn, Joanne

AU - Harrell, Frank E.

AU - Califf, Robert

AU - Kussin, Peter

AU - Connors, Alfred F.

AU - Bellamy, Paul

AU - Vidaillet, Humberto

PY - 1995/6/21

Y1 - 1995/6/21

N2 - To develop and validate a simple prognostic scoring system to identify patients in nontraumatic coma at high risk for poor outcomes using data available early in the hospital course. —Prospective cohort study. —Five geographically diverse academic medical centers. —A total of 596 patients in nontraumatic coma enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments(SUPPORT), including 247 in the model derivation set and 349 in the model validation set. —Death and severe disability by 2 months. —For the 596 patients studied(median age, 67 years; 52% female), the primary cause of coma was cardiac arrest in 31% and cerebral infarction or intracerebral hemorrhage in 36%. At 2 months 69% had died, 20% had survived with known severe disability, 8% were known to have survived without severe disability, and 3% survived with unknown functional status. Five clinical variables available on day 3 after enrollment were associated independently with 2-month mortality: abnormal brain stem response(adjusted odds ratio [OR]=3.2; 95% confidence interval [CI], 1.3 to 8.1), absent verbal response(OR=4.6; 95% CI, 1.8 to 11.7), absent withdrawal response to pain(OR=4.3; 95% CI, 1.7 to 10.8), creatinine level greater than or equal to 132.6 μmol/L(1.5 mg/dL)(OR=4.5; 95% CI, 1.8 to 11.0), and age of 70 years or older(OR=5.1; 95% CI, 2.2 to 12.2). Mortality at 2 months for patients with four or five of these risk factors was 97%(58/60; 95% CI, 88% to 100%) in the validation set. Brain stem and motor responses best predicted death or severe disability by 2 months. For patients with either an abnormal brain stem response or absent motor response to pain, the rate of death or severe disability at 2 months was 96%(185/193; 95% CI, 92% to 98%) in the validation set. —Five readily available clinical variables identify a large subgroup of patients in nontraumatic coma at high risk for poor outcomes. This risk stratification approach offers physicians, patients, and patients’ families information that may prove useful in patient care decisions and resource allocation.(JAMA 1995;273:1842-1848).

AB - To develop and validate a simple prognostic scoring system to identify patients in nontraumatic coma at high risk for poor outcomes using data available early in the hospital course. —Prospective cohort study. —Five geographically diverse academic medical centers. —A total of 596 patients in nontraumatic coma enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments(SUPPORT), including 247 in the model derivation set and 349 in the model validation set. —Death and severe disability by 2 months. —For the 596 patients studied(median age, 67 years; 52% female), the primary cause of coma was cardiac arrest in 31% and cerebral infarction or intracerebral hemorrhage in 36%. At 2 months 69% had died, 20% had survived with known severe disability, 8% were known to have survived without severe disability, and 3% survived with unknown functional status. Five clinical variables available on day 3 after enrollment were associated independently with 2-month mortality: abnormal brain stem response(adjusted odds ratio [OR]=3.2; 95% confidence interval [CI], 1.3 to 8.1), absent verbal response(OR=4.6; 95% CI, 1.8 to 11.7), absent withdrawal response to pain(OR=4.3; 95% CI, 1.7 to 10.8), creatinine level greater than or equal to 132.6 μmol/L(1.5 mg/dL)(OR=4.5; 95% CI, 1.8 to 11.0), and age of 70 years or older(OR=5.1; 95% CI, 2.2 to 12.2). Mortality at 2 months for patients with four or five of these risk factors was 97%(58/60; 95% CI, 88% to 100%) in the validation set. Brain stem and motor responses best predicted death or severe disability by 2 months. For patients with either an abnormal brain stem response or absent motor response to pain, the rate of death or severe disability at 2 months was 96%(185/193; 95% CI, 92% to 98%) in the validation set. —Five readily available clinical variables identify a large subgroup of patients in nontraumatic coma at high risk for poor outcomes. This risk stratification approach offers physicians, patients, and patients’ families information that may prove useful in patient care decisions and resource allocation.(JAMA 1995;273:1842-1848).

UR - http://www.scopus.com/inward/record.url?scp=0029022818&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029022818&partnerID=8YFLogxK

U2 - 10.1001/jama.1995.03520470050031

DO - 10.1001/jama.1995.03520470050031

M3 - Article

C2 - 7776500

AN - SCOPUS:0029022818

VL - 273

SP - 1842

EP - 1848

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 23

ER -