Skip to main content
SpringerLink
Log in

Classifications of coma

  • Current Practice
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Coma classifications have been a matter of debate for over 35 years. The Glasgow Coma Scale is now widely accepted but its indiscriminate application has often led to misuse. The various methods that have been devised can be divided into two types, coma scales and coma scoring systems. In this critique the origins and values of these methods are analysed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Barge M, Ohanessian J, Baum L, Benabid AL, Chirossell JP (1977) Valeur diagnostique et prognostique des réflexes du tronc cérébral dans les comas post-traumatiques graves. Neurochirurgie 23:227

    Google Scholar 

  2. Barge M, Ohanessian J, Garrel S, Benabid AL, Chirossel JP (1978) Le stade mésodiencéphalique des traumatismes cranies graves. Neurochirurgie 24:33

    Google Scholar 

  3. Bates D, Caronna TJ, Cartlidge NEF, Knill-Jones MB, Levy DE, Shaw MB, Plum F (1977) A prospective study of non-traumatic coma: methods and results in 310 patients. Ann Neurol 2:211

    Google Scholar 

  4. Boselli L, Bozza-Marrubini M, Farina M, Levati A, Minella C, Vecchi G (1981) Correlation between outcome and time course of brain stem reflexes suppression in severe head injuries. Crit Care Med 9:207 (Abstract)

    Google Scholar 

  5. Bozza-Marrubini M (1961) Rianimazione. I. Alterazioni del sensorio. In: Bozza-Marrubini M, Rossanda M, et al. (eds) Anestesia e rianimazione nella chirurgia e nella traumatologia del sistema nervoso centrale. Minverva Anestesiol 27:365

  6. Bozza-Marrubini M (1964) Resuscitation treatment of the different degrees of unconsciousness. Acta Neurochir 12:352

    Google Scholar 

  7. Bozza-Marrubini M (1982) Coma. In: Tinker J, Rapin M (eds), Care of the critically ill patient. Springer, Berlin, p 719

    Google Scholar 

  8. Bozza-Marrubini M (1983) Classificazione del coma In: Cattaneo AD (ed) Coma. Recenti progressi di clinica e terapia. Piccin, Padova, p 27

    Google Scholar 

  9. Bozza-Marrubini M (1984) Toxic brain failure syndromes. In: Blum K, Manzo L (eds) Neurotoxicology. M. Dekker Inc, New York (in press)

    Google Scholar 

  10. Bricolo A, Battistini N, Bergamini L, Columella F, Loeb C, Mingrino S, Rossi GF, Terzian H (1975) A proposal for the clinical classification of acute coma due to organic cerebral lesions. J Neurosurg Sci 19:113

    Google Scholar 

  11. Bricolo A, Faccioli F, Turazzi S (1979) L'EEG dans le coma traumatique aigu. Valeur diagnostique et prognostique. Rev. E. E. G. Neurophysiol 9:116

    Google Scholar 

  12. Brinkmann R, Von Cramon D, Schulz H (1976) The Munich Coma Scale (MCS). J Neurol Neurosurg Psychiatry 39:788

    Google Scholar 

  13. Choi SC, Ward JD, Becker DB (1983) Chart for outcome prediction in severe head injury. J Neurosurg 59:294

    Google Scholar 

  14. Cooper PR, Moody S, Clark K, Kirkpatrick, J, Maravilla K, Gould AL, Drane W (1979) Dexamethasone and severe head injury. A prospective double-blind study. J Neurosurg 51:307

    Google Scholar 

  15. Courjon J (1970) Apport de l'exploration fonctionnelle du systheme nerveux dans le diagnostic et le prognostic des traumatismes crâniens récents. Acta Psychiatr Belg 70:359

    Google Scholar 

  16. Espagno C, Tremoulet M, Gigaud M, Poletto B, Espagno J (1978) Les niveaux de souffrance axiale due traumatisme cranien grave. Etude critique. Neurochirurgie 24:257

    Google Scholar 

  17. Fischgold H, Mathis P (1959) Obnubilations, comas et stupeurs. Masson, Paris

    Google Scholar 

  18. Frowein RA (1976) Classification of coma. Acta Neurochir (Wien) 34:5

    Google Scholar 

  19. Gesterbrand F, Lücking CH (1970) Die akuten traumatischen Hirnstammschäden. Arch Psychiat Nervenkr 213:264

    Google Scholar 

  20. Goulon M, Gajdos P, Margent P, Raphael JC, Barois A, Combes A, Grosbuis S, Levy-Alcover M, Gastinne H (1977) Neurological problems in intensive care. In: NeurologyProceedings 11th World Congress of NeurologyAmsterdam1977. International Congress Series no. 434 Excerpta Medica, Amsterdam Oxford, p 283

    Google Scholar 

  21. Jouvet M (1961) Essal de classification des troubles chroniques de la conscience post-traumatiques. In: Wertheimer P, Descotes J (eds) Traumatologie cranienne. Masson, Paris, p 75

    Google Scholar 

  22. Jouvet M (1969) Coma and other disorders of consciousness. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, vol 3. North Holland, Amsterdam, p 62

    Google Scholar 

  23. Langfitt TW, Gennarelli TA (1982) A holistic view of head injury including a new clinical classifiction. In: Grossman RG, Gildenberg G (eds) Head injury: basic and clinical aspects. Raven Press, New York, p 1

    Google Scholar 

  24. Langfitt TW, Gennarelli TA (1982) Can the outcome from head injury be improved? J Neurosurg 56:19

    Google Scholar 

  25. Levati A (1977) Possibilità di prognosi precoce nel traumatizzato cranio-encefalico. Importanza del livello di coma e dell'età. Thesis, University of Milan

  26. Levati A, Farina ML, Vecchi G, Rossanda M, Bozza-Marrubini M (1982) Prognosis of severe head injuries. J Neurosurg 57:779

    Google Scholar 

  27. Levy DE, Bates D, Caronna JJ, Cartlidge NEF, Knill-Jones RP, Lapinski RH, Singer BH, Shaw DA, Plum F (1981) Prognosis in nontraumatic coma. Ann Int Med 92:293

    Google Scholar 

  28. Lorenzoni E (1975) Das EEG im posttraumatischen Koma. Fortschr Neurol Psychiatr 43:155

    Google Scholar 

  29. Marshall LF, Becker DP, Bowers SA, Cayard C, Eisenberg H, Gross CR, Grossman RG, Jane JA, Kunitz SC, Rimel R, Tabaddor K, Warren J (1983) The National Traumatic Coma Data Bank, Part 1: Design, purpose, goals and results. J Neurosurg 59:276

    Google Scholar 

  30. Marshall LF, Toole BM, Bowers SA (1983) The National Traumatic Coma Data Bank. Part 2: Patients who talk and deteriorate: implications for treatment. J Neurosurg 59:285

    Google Scholar 

  31. Matthew H, Lawson AAH (1975) Treatment of Common Acute Poisonings. Churchill Livingstone, Edinburgh London New York, p 18

    Google Scholar 

  32. Miller JD, Butterworth JF, Gudeman SK, Faulkner JE, Choi SC, Selhorst JB, Harbison JW, Lutz HA, Young HF, Becker DP (1981) Further experience in the management of severe head injury. J Neurosurg 54:289

    Google Scholar 

  33. Mollaret P, Goulon M (1959) Le coma dépassé. Rev Neurol (Paris) 101:3

    Google Scholar 

  34. Narayan RK, Greenberg RP, Miller JD, Enas GG, Choi SC, Kishore PRS, Selhorst JB, Lutz HA, Becker DP (1981) Improved confidence of outcome prediction in severe head injury. J Neurosurg 54:751

    Google Scholar 

  35. Obrist WD, Gennarelli TA, Segawa H, Dolinskas CA, Langfitt TW (1979) Relation of cerebral blood flow to neurological status and outcome in head injured patients. J Neurosurg 51:292

    Google Scholar 

  36. Overgaard J, Christensen S, Hvid-Hansen O, Haase J, Land A, Hein O, Pedersen KK, Tweed WA (1973) Prognosis after head injury based on early clinical examination. Lancet 2:631

    Google Scholar 

  37. Perez Dominguez EP, Frerebeau, P, Privat JM, Bazin M, Benezech J, Gros C (1978) Intérêt de l'étude des réflexes du tronc cérébral au cours du coma. Neurochirurgie 24:261

    Google Scholar 

  38. Plum F (1972) Organic disturbances of consciousness. In: Critchley M, O'Leary JL, Jennett B (eds) Scientific foundations of neurology, Heinemann, London, pp 193–201

    Google Scholar 

  39. Plum F, Posner JB (1966) The diagnosis of stupor and coma. Blackwell, Oxford

    Google Scholar 

  40. Plum F, Posner JB (1982) The diagnosis of stupor and coma. Davis, USA

  41. Reed CE, Driggs MF, Foote CC (1952) Acute barbiturate intoxication: a study on 300 cases based on a physiologic system of classification of the severity of the intoxication. Ann Intern Med 37:290

    Google Scholar 

  42. Rowbotham GF (1949) Acute injuries of the head. Livingstone, Edinburgh, p 123–125

    Google Scholar 

  43. Rumpl E, Gesterbrand F, Hackl JM, Lorenzi E, Aichner F (1979) Corrélations électrocliniques au stade initial des syndromes mésencéphaliques et bulbaires post-traumatiques. Rev E.E.G. Neurophysiol 9:131

    Google Scholar 

  44. Safar P (1981) Cardiopulmonary cerebral resuscitation. Laerdal, Stavanger (Norway), p 149

    Google Scholar 

  45. Sano K, Manaka S, Kitamura K, Kagawa M, Takeuchi K, Ogashiwa M, Kameyama M, Tohgi H, Yamada H (1983) Statistical studies on evaluation of mild disturbance of consciousness. J Neurosurg 58:223

    Google Scholar 

  46. Stablein DM, Miller JD, Choi SC, Becker DB (1980) Statistical methods for determining prognosis in severe head injury. Neurosurgery 6:243

    Google Scholar 

  47. Subczynski J (1975) State of consciousness scoring system. J Neurosurg 43:251

    Google Scholar 

  48. Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81

    Article  CAS  PubMed  Google Scholar 

  49. Teasdale G, Jennett B (1976) Assessment and prognosis of coma after head injury. Acta Neurochir (Wien) 34:45

    Google Scholar 

  50. Vigouroux MR (1972) Nouvel essai de classification des états frontières entre la vie et la mort. Neurochirurgie 18:53

    Google Scholar 

  51. Young B, Rapp RP, Norton JA, Haack D, Tibbs PA, Bean JR (1981) Early prediction of outcome in head injured patients. J Neurosurg 54:300

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Servizio di Rianimazione e Terapia Intensive, Ospedale Niguarda-Ca Granda, Milano, Italy

    M. Bozza Marrubini

Authors
  1. M. Bozza Marrubini
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marrubini, M.B. Classifications of coma. Intensive Care Med 10, 217–226 (1984). https://doi.org/10.1007/BF00256257

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00256257

Key words

Search

Navigation