CLINICAL RECOVERY OF CONSCIOUSNESS AFTER TRAUMATIC COMA

Objective: To describe early clinical stages in the recovery of consci ousness, using selected items from the Glasgow Coma Scale and the Lieg e Coma Scale. Design: Validation cohort study, conducted in a tertiary care center. Setting: Neurosurgical intensive therapy unit in a unive rsity teaching hospital. Patients: Patients (n = 137) with traumatic c oma who were selected according to the following criteria: a) coma due to blunt head trauma with an initial Glasgow Coma Score of less than or equal to 7; b) admission to the neurosurgical intensive therapy uni t within the first 24 hrs after trauma; c) patients >14 yrs of age; re quiring endotracheal intubation, mechanical ventilation, and the admin istration of drugs; and d) survival period allowing analysis of the re covery of consciousness. Measurements and Main Results: Arousal, as ex pressed by stimulated opening of the eyes and recorded as a delay in d ays, was correlated with the appearance of the localized pain response , capacity to obey commands, blink reflex, and the cessation of drugs in three groups of patients. These groups were defined according to th e time in which there was an appearance of the stimulated opening of t he eyes: <8 days (group 1); between 8 and 15 days (group 2); and after 15 days (group 3). When the three groups of patients were compared, s ignificant differences existed between the mean delays of appearance o f stimulated eye opening and the appearance of the blink reflex. Extub ation coincided with the appearance of spontaneous eye opening, with a mean delay of 13.5 days. Conclusions: This study confirms the classic al clinical sequence of arousal and recovery of consciousness, with th e appearance of stimulated eye opening and the blink reflex first, fol lowed by spontaneous eye opening, and the capacity to obey commands in intubated, traumatized, coma patients. A direct correlation existed b etween the delay of arousal and the complete recovery of consciousness . When groups of patients with various mean delays for the appearance of stimulated eye opening are considered, reappearance of the blink re flex did not always coincide with stimulated eye opening, suggesting d iffering structural and functional brain recovery processes.