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"In spite of medical advances and the increasing number of severely brain-injured patients, the assessment and treatment of patients recovering from coma remain challenging. For over 10 years now, the Coma Science Group has been working on the scientific exploration of disorders of consciousness, with both scientific and clinical research agendas. This book is the result of all this work. The aim is to offer both clinicians and researchers an opportunity to acquire expertise in a field which is constantly developing.Besides diagnostic, prognostic and ethical issues, this book includes well-established findings on assessment techniques (i.e., behavioral scales, electrophysiological explorations and structural/functional neuroimaging) and treatment procedures, but also techniques under development (i.e., the use of classifiers, brain-computer interfaces, transcranial magnetic stimulation or deep brain stimulation) which will stimulate ideas for future research."

"introduction about Consciousness"

"ABSTRAK Latar belakang Pasien penurunan kesadaran merupakan salah satu kasus yang sering ditemui di Instalasi Gawat Darurat IGD Penilaian awal diperlukan untuk memberikan informasi kepada keluarga pasien mengenai kemungkinan yang akan terjadi dan membantu keluarga dalam pengambilan keputusan GCS telah menjadi salah satu penilaian yang digunakan untuk menilai luaran pasien penurunan kesadaran tetapi dinilai masih kurang dalam memprediksi luaran yang terjadi Penelitian ini bertujuan untuk menilai gabungan GCS tekanan darah sistolik dan umur dapat memprediksi luaran pasien penurunan kesadaran Metode Penelitian ini merupakan studi observasional kohort retrospektif 76 pasien penurunan kesadaran yang datang ke IGD RSUPN Cipto Mangunkusumo Peneliti melakukan pencatatan penilaian Glasgow Coma Scale GCS tekanan darah sistolik dan umur saat pasien diperiksa di triase Luaran dinilai setelah dua minggu pasca kedatangan di IGD Hasil Hasil analisis bivariat pada GCS dan umur memperoleh hasil berbeda bermakna antara pasien kelompok luaran buruk dengan kelompok luaran baik p.ABSTRACT Background Patients loss of consciousness is one case that is often encountered in the Emergency Room ER The initial assessment is required to provide information to the patient 39 s family about the possibility that will happen and help families in decision making GCS has become one assessment used to assess outcomes of patients with loss of consciousness but is insufficient in predicting the outcome of some cases This study aims to assess the combined GCS systolic blood pressure and age can predict the outcome of patients with loss of consciousness Methods This was a retrospective cohort observational study 76 patients with loss of consciousness that comes into the ER RSUPN Cipto Mangunkusumo Researchers conducted the recording of the Glasgow Coma Scale GCS systolic blood pressure and age when patients checked in triage Outcomes assessed after two weeks after arrival in the emergency room Results The results of the bivariate analysis on the GCS and ages get results significantly different between patients with poor outcome group with good outcome group p ."

"Penurunan kesadaran merupakan suatu keadaan darurat medis yang harus segera ditangani dengan tepat untuk mengurangi kerusakan lebih lanjut. Glasgow Coma Scale (GCS) yang digunakan untuk menilai tingkat kesadaran pada pasien penurunan kesadaran akan memberikan gambaran keparahan dari kerusakan otak dan memprediksi outcome. Tujuan: Mengetahui ketepatan GCS dalam memprediksi outcome pada pasien dengan penurunan kesadaran di Instalasi Gawat Darurat RSCM. Metode: Penelitian ini merupakan studi observasional, kohort prospektif. 116 pasien usia ≥ 18 tahun dengan Glasgow Coma Scale dibawah 15 saat tiba di IGD RSCM Jakarta. Glasgow Coma Scale sampel dinilai sebanyak 1 kali ketika pasien pertama kali diterima di IGD RSCM. Peneliti mengevaluasi outcome pasien dua minggu setelah masuk IGD RSCM berdasarkan kriteria Glasgow Outcome Scale. Hasil Rerata usia pasien 51,4 ± 16,4 tahun, median GCS 9 (3- 14). Hasil: Glasgow Outcome Scale diklasifikasi menjadi bad outcome (meninggal dan disabilitas berat) 66 pasien (56,9%) dan good outcome (disabilitas sedang dan sembuh) 50 pasien (43,1%). Skor GCS pasien kelompok bad outcome berbeda bermakna dengan kelompok good outcome berdasarkan analisis statistik (p < 0,001). Skor GCS-E, GCS-M dan GCS-V masing-masing pasien kelompok bad outcome berbeda bermakna dengan kelompok good outcome berdasarkan analisis statistik (p < 0,001). Hasil regresi logistik, komponen GCS yang memiliki nilai prediksi terhadap outcome adalah komponen verbal dan membuka mata. Hasil uji kalibrasi skor GCS total dan skor GCS E+V memiliki kualitas yang baik. Hasil uji diskriminasi menunjukkan skor GCS total mempunyai nilai AUC 0,788 (IK95% 0,705-0,870). Skor GCS E+V mempunyai AUC 0,777 (IK95% 0,690-0,864). Titik potong GCS adalah ≤ 9. Uji Kappa antara dokter dan perawat terhadap skor GCS menunjukkan hasil yang sangat kuat Kappa 0,901 (p < 0,001). Kesimpulan: Skor Glasgow Coma Scale mampu memprediksi outcome dengan tepat pada pasien dengan penurunan kesadaran di Instalasi Gawat Darurat RSCM, karena memiliki kalibarasi dan diskriminasi yang baik.

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Altered level of consciousness is a medical emergency that must be manage immediatly to reduce further damage. Glasgow Coma Scale (GCS) is used to assess the level of consciousness in citically ill patients. GCS indicates the severity of brain damage and predictor of patient outcomes.

Objective: To assess accuracy of GCS in predicting outcome for patients with altered level of consciousness in Emergency Department of Cipto Mangunkusumo Hospital.

Method: This study is a observational prospective cohort study. Samples were 116 patients aged ≥ 18 years with a Glasgow Coma Scale below 15 at the time of admisssion in the Emergency Department of Cipto Mangunkusumo Hospital. Glasgow Coma Scale was assessed when patients first arrived in the Emergency Department. To assess outcome, researchers used The Glasgow Outcome Scale. Glasgow Outcome Scale was reviewed 2 weeks after admission for every sample.

Results: The mean patient age was 51.4 ± 16.4 years, median GCS 9 (3-14). The Glasgow Outcome Scale classified into bad outcome (death and severe disability) 66 patients (56.9%) and good outcome (moderate disability and good recovery) 50 patients (43.1%). The difference in GCS score between both outcome group were statistically significant (p < 0,001). Each of patient's GCS-E, GCS and GCS-M-V in bad outcome groups differ significantly with good outcome group (p < 0,001). The results of logistic regression, GCS components that have predictive value to the outcome are verbal and eye opening component. Calibration test showed that total GCS score and GCS E+V score has good quality. The results of discrimination test showed total GCS score has a AUC of 0.788 (IK95% from 0.705 to 0.870). GCS score E+V has AUC of 0.777 (IK95% from 0.690 to 0.864). GCS's cut off point was ≤ 9. Kappa Test between doctors and nurses to the GCS score showed very strong results of Kappa 0.901 (p < 0,001).

Conclusion: Glasgow Coma Scale can predict outcome in patients with altered level of consciousness in the Emergency Department of Cipto Mangunkusumo Hospital, because of its good calibration and discrimination."