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March 28, 1986

Predicting the Outcome From Hypoxic-Ischemic Coma

Author Affiliations

Copenhagen City Hospital Denmark

JAMA. 1986;255(12):1569-1570. doi:10.1001/jama.1986.03370120043011

To the Editor.—  In the Sept 6, 1985, issue of The Journal, Dr Black1 expressed major reservations about applying the scheme for predicting the outcome of hypoxic-ischemic coma suggested by Levy et al.2 One important objection was that the scheme is based on retrospective data. Other serious methodological drawbacks are as follows: (1) The data analyzed in retrospect concern patients seen on occasion at three medical centers with different clientele and treatment strategies,3,4 thereby making the possibility of interobserver variability very high. (2) The neurological findings are graded in a "worst to best" order and the greatest predictive weight is assigned to the response considered "best" at random examination time. However, any of the signs explored may be a facet of the orderly recovery. (3) The outcome categories are defined in the same way as are the end points of head trauma,5 including eventual "dependency" on