Department of Neurology, National Hospital Organization, Minami Kyoto Hospital, Joyo, Kyoto, Japan.
BMJ Open. 2013 Apr 29;3(4). doi: 10.1136/bmjopen-2013-002736. Print 2013.
Prompt 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.
A cohort study.
A prefectural stroke registry.
We 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).
We 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.
A 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.
Using 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.
在脑卒中患者的急救过程中，快速评估意识水平至关重要。日本昏迷量表（JCS）是 1974 年发表的一种单轴昏迷量表，具有极高的简洁性。假设 JCS 足以预测脑卒中结局。本研究旨在验证 JCS 的预测能力，这有助于 JCS 获得国际认可。
队列研究。
县级脑卒中登记处。
我们分析了 1999 年 1 月至 2009 年 12 月期间整个京都府内的 13788 例脑卒中患者，这些患者均被登记在京都脑卒中登记处（KSR）。
我们调查了基于脑卒中发病时 JCS 和发病 30 天内日常生活活动（ADL）或 30 天内死亡的意识水平与大型基于人群的脑卒中登记处之间的关系。我们计算了 JCS 与 ADL 量表之间的相关性的斯皮尔曼系数，通过 Kaplan-Meier 方法生成估计的生存曲线，最后比较了根据 JCS 不同意识水平的患者发病后 30 天内的死亡风险比（HR）。
共有 13406 例（97.2%）患者根据 JCS 进行了评分。JCS 与 ADL 量表相关，斯皮尔曼相关系数为 0.61。发病后 30 天内死亡的 HR 分别为 1（参考）（95%置信区间）、5.55（4.19 至 7.37）、9.54（7.16 至 12.71）和 35.21（26.10 至 44.83），评分分别为 JCS0、JCS1、JCS2 和 JCS3。
使用单一的眼部反应测试，JCS 作为昏迷量表具有出色的优点，即简单性和适用性。本研究增加了对脑卒中患者早期结局的预测能力。JCS 具有很高的价值，特别是在需要快速评估意识水平的紧急情况下。
