The eye response test alone is sufficient to predict stroke outcome—reintroduction of Japan Coma Scale: a cohort study

Abstract

ObjectivesPrompt assessment of consciousness levels is vitally important during the emergency care of stroke patients. The Japan Coma Scale (JCS) is a one-axis coma scale published in 1974 with outstanding simplicity. The hypothesis is that JCS is sufficient to predict stroke outcome. The aim of the study was to verify the predictability of JCS, which should help JCS attain international recognition.DesignA cohort study.SettingA prefectural stroke registry.ParticipantsWe analysed 13 788 stroke patients identified from January 1999 to December 2009 inclusive in the entire Kyoto prefecture and registered in the Kyoto Stroke Registry (KSR).Main outcome measuresWe investigated the relationship between consciousness levels, based on JCS at stroke onset and activities of daily living (ADL) at 30 days or deaths within 30 days in a large population-based stroke registry. We calculated Spearman's coefficient for the correlation between JCS and the ADL scale, generated estimated survival curves by the Kaplan-Meier method and finally compared HRs for death within 30 days after onset, comparing patients with different conscious levels based on JCS.ResultsA total of 13 406 (97.2%) patients were graded based on JCS. JCS correlated to the ADL scale with Spearman's correlation coefficient of 0.61. HRs for death within 30 days were 1 (reference) (95% CIs), 5.55 (4.19 to 7.37), 9.54 (7.16 to 12.71) and 35.21 (26.10 to 44.83) in those scored as JCS0, JCS1, JCS2 and JCS3, respectively.ConclusionsUsing a single test of eye response, JCS has outstanding merits as a coma scale, that is, simplicity and applicability. The present study adds predictability for early outcome in stroke patients. JCS is valuable, especially in an emergency setting, when a prompt assessment of consciousness levels is needed.

Two-Year Survival After First-Ever Stroke in a General Population of 1.4 Million Japanese ― Shiga Stroke Registry ―

“…22, 23 There is limited evidence, however, for the association between on-admission JCS score and non-acute fatality after stroke. In the present Advance Publication by-J-STAGE Advance Publication by-J-STAGE embolic infarction, intracerebral hemorrhage and subarachnoid hemorrhage.…”

Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage: a nationwide study in Japan (J-ASPECT Study)

“…9 In addition, JCS scores have been reported to correlate with stroke outcomes. 29 Therefore, we believe that the JCS is sufficient for clinical grade assessment in patients with SAH. However, as an increasing number of stroke researchers have used JCS scores in recent Japanese DPC database studies, 2,9,12,14,25,30,33 it may be necessary to compare the JCS scoring system with more typical grading scales.…”

“…4 The JCS is the most widely used grading scale for assessing impaired consciousness in Japan (Supplementary Table S1). 14,29 This scale represented levels of consciousness upon admission regardless of whether patients had subsequently undergone ventriculostomy or CSF shunt placement.…”

“…Although McDonald et al performed propensity score analysis to minimize potential selection bias, SAH severity was not included in the patient variables used to generate propensity scores, making interpretation of the results difficult. 17 On the other hand, SAH severity was adjusted by the JCS score 14,25,29 in the present study, minimizing its confounding effects. Notably, the importance of the JCS, first developed in 1974 for the prediction of stroke outcomes, has recently been validated.…”

“…Notably, the importance of the JCS, first developed in 1974 for the prediction of stroke outcomes, has recently been validated. 29 The second most common cause of SAH-related death and poor functional outcome is rebleeding. 5,16 Earlier treatment of ruptured aneurysms reduces the incidence of rebleeding.…”