抄録
For the comparison of differential effects of various therapeutic modalities on the outcome of subarachnoid hemorrhages (SAH) due to ruptured aneurysms, a need for clinical scales precisely correlated to the severity of SAH has been emphasized. However, it is easily anticipated that such severity-scales must include numerous items because of multiple determinants of the severity of SAH. Severity scales with too many items may be unpractical. Furthermore, the weight of each determinant for the severity is largely unknown. Thus, with the emphasis on objectivity and practicability, we examined in the present study whether coma-scales can be used as a severity scale.
A concept of severity may correspond to the outcome with standard modality of treatments. Thus, we correlated assessments with coma-scales during acute periods after SAH and the outcome. Japan Coma Scale (3-3-9 scale, JCS), Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) were employed. Preliminary results indicated that assessments with coma-scales were positively correlated to the outcome and therefore the severity. It was, however, noted that there existed several factors which differently influenced coma-scales and the actual severity. Reversible deep coma within initial 24 hours after SAH were not correlated to the severity. SAH associated with intraventricular hemorrhages had a tendency to deteriorate the actual severity more than the coma-scales. In contrast, SAH associated with intracerebral hematoma appeared to be reflected more easily to the assessments with coma-scales than the actual severity.
We believe that differential correlation of coma-scales to the actual severity under various pathological states is not a shortcomming of the use of coma-scales as a severity-scale but is rather an advantage that differential weight of each pathological state for the actual severity can be clearly demonstrated. Future studies with larger series of patients, which would identify major factors affecting coma-scales and the actual severity differentially, may facilitate the use of coma-scales as a practical, objective and useful severity-scale in SAH due to ruptured aneurysms.
