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

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Correspondence

Reply

^a Department of Cardiovascular Surgery, Hospital Santa Maria, via de Ferraris 18, Bari, 70124 Italy
^b Department of Cardiac Surgery, Vanderbilt University Medical Center, 1215 21^st Avenue, S, Nashville, TN 37232-8815

(Email: marzia_leacche{at}hotmail.com; john.byrne{at}vanderbilt.edu).

To the Editor:

We thank Dr Cunningham [1] for his constructive comments on our report [2] and the editor for giving us the opportunity to reply.

The Glasgow Coma Scale (GCS) is the most widely used scoring system in quantifying level of consciousness after traumatic brain injury [3]. It is based on three indicators of cerebral function: (1) the best eye opening response, (2) the best verbal response, and (3) the best motor response. The score represents the sum of the numeric scores of each of the categories. The sum obtained in this scale is used to assess Coma and Impaired Consciousness; mild head injury is 13 to 15 points, moderate is 9 to 12 points, and severe is 3 to 8 points. In most trauma and neurosurgical centers it is commonly accepted that patients with a score 8 are in coma, and patients with a score above 8 have an impaired consciousness.

There are limitations to its use. If the patient has an endotracheal tube in place, then they are unable to communicate. For this reason, many prefer to document the score by its individual components.

In the cardiac intensive care unit (ICU), the GCS is usually used, although it is mutuated from the trauma ICU and patients are usually intubated. We agree with Dr Cunningham [1] that the word coma should be used for patients with GCS 8, but we found in our cardiac ICU population that even a mild head injury with a GCS of 14 to 12 had a great impact on survival. Moreover in 27 patients, the mean GCS was 8 (6.2 ± standard deviation of 7.7 [range, 3–14]), with only 1 patient having a GCS of 14. Thus, more patients were in coma or had moderate-severe brain injury than impaired consciousness. To simplify the table and the reading of the article, we used the term coma giving our definition criterion instead of using both coma and impaired consciousness.

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1. Cunningham JM. Definition of coma in postoperative cardiac surgery patients requiring renal replacement therapy(letter) Ann Thorac Surg 2007;83:1232.[Free Full Text]
2. 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]
3. Teasdale G, Jennet B. Assessment of coma and impaired consciousness: a practical scale Lancet 1974;2:81-84.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marzia Leacche John G. Byrne Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Leacche, M. Articles by Byrne, J. G. Search for Related Content PubMed Articles by Leacche, M. Articles by Byrne, J. G. Related Collections Related Article