Emerging from a Coma: Clinical Evaluation Tools
There are few investigations regarding the diagnostic tools for evaluating changes of consciousness in the early stages of recovering from a coma. This period, when the first signs of recovered consciousness appear, happen in the ICU embracing a variable period of time. In some patients, signs of awakening appear even during the mechanical ventilation stage, and conversely, in other patients only appear in a delayed phase.
But what are the first neurological clinical signs of recovering from a coma? What are the most powerful signs in predicting complete recovery from a coma? And what standard scales for evaluating consciousness must be used during this clinical period?
The main objective of our research was to analyse some pre-existing consciousness evaluation scales during recovery from a coma. The study group was formed by patients in a coma (due to stroke and to head injury). A strict protocol of diagnosis and treatment was followed. The evaluation tools included standard scales such as : Glasgow Coma Scale, Innsbruck Scale, Edinburgh-2 Scale, Neurological Assessment Revised, Rancho de Los Amigos Scale, Near-Coma Semi-Coma Scale and Disability Rating Scale. As well as these, some clinical signs, usually suggestive of recovery of consciousness (spontaneous movement, eye tracking, etc) were also evaluated.
The existence of daily changes in the score of the scales and clinical signs studied associated with recovery of consciousness and cognitive functions were considered as a strong and accurate marker of the predictions of recovery from the coma.
Our final results showed that none of the scales evaluated had a significant accuracy in the evaluation of awakening after coma. However, some of the items included in them and some of the clinical signs analysed, showed a high prediction weight . Probably the combination of these items, together with clinical signs would help to develop a powerful scale for evaluating recovery from coma.