hypoxic-ischemic coma prognosis

When you are on you're on your neurology clerkship (or ICU rotations) you will undoubtedly encounter many patients in post-stroke comas. A good physical/neuro exam can help a lot with ultimate prognosis. After 7 days prognosis is almost always apparent. Here is a validated method based on Based on Levy et al JAMA 1985, 253

GOOD = mod disability (independent w/ ADLs) or better
POOR = death, persistent coma until death, or persistent veg state.

< 3hrs

• GOOD (41% good, 41% bad)
• Eyes: Roving conjugate
• Motor: Posturing or better
• POOR (94% bad, 0% good)

24 hrs.

• GOOD (63% good, 7% bad)
• Eyes: Open to noise / spontaneously
• Motor: Withdraw or better
• POOR (95% bad, 1% good)

3 days

• GOOD (77% good, 8% bad)
• Eyes: Normal orienting movements
• Motor: Withdraw or better
• POOR (93% bad, 0% good)

7 days

• GOOD (72% good, 6% bad)
• Obeys commands
  
• POOR (100% bad, 0% good)