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Ann Thorac Surg 2007;83:1232
© 2007 The Society of Thoracic Surgeons

Correspondence

Definition of Coma in Postoperative Cardiac Surgery Patients Requiring Renal Replacement Therapy

James M. Cunningham, MD

Mercer University School of Medicine, 777 Hemlock St, Box 27, Macon, GA 31201

(Email: cunningham.james{at}mccg.org).

To the Editor:

I congratulate Dr Leacche and associates [1] on their effort to develop a prediction score for in-hospital mortality associated with the need for renal replacement therapy in postoperative cardiac surgery patients. However, I would like to point out what appears to be an error in their definition of coma relating to the Glasgow Coma Scale (GCS). According to the authors’ definition, a patient was considered to be in a coma if the GCS score was <15 (Table 6 and paragraph 2 in the "Comment" section of the article). Most neurologists, neurosurgeons, and trauma surgeons would consider a GCS <8 to be indicative of coma. In the intensive care unit setting, very few patients will have a perfect score of 15. Many postoperative patients are at least slightly confused and would therefore receive a GCS score of 14, but are obviously not comatose.


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  1. Leacche M, Winkelmayer WC, Subroto P, et al. Predicting survival in patients requiring renal replacement therapy after cardiac surgery Ann Thorac Surg 2006;81:1385-1392.[Abstract/Free Full Text]

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Marzia Leacche and John G. Byrne
Ann. Thorac. Surg. 2007 83: 1232. [Extract] [Full Text] [PDF]



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Ann. Thorac. Surg., March 1, 2007; 83(3): 1232 - 1232.
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