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Despite diverse causes, certain principles do apply: (1) Many patients can improve, although with significant abnormalities; (2) Neuroimaging and electrodiagnostic tests can help but are rarely definitive; (3) Secondary involvement of the upper brainstem marks a tipping point with much lower probability for an independent outcome; (4) We rarely predict mortality or diagnose brain death; usually the major concern is anticipated neurological deficits; and (5) Prior comorbidity and permanent organ dysfunction are critical factors in making decisions about de-escalation or escalation of care. This review provides a practical approach to evaluating outcome of a comatose patient. Prognostication is difficult, and we should only attempt it when the diagnosis is confirmed and appropriate (often aggressive) medical or surgical treatment has been tried.<\/jats:p>","DOI":"10.1136\/practneurol-2019-002359","type":"journal-article","created":{"date-parts":[[2019,9,19]],"date-time":"2019-09-19T17:15:35Z","timestamp":1568913335000},"page":"26-33","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Predicting the outcome of a comatose patient at the bedside"],"prefix":"10.1136","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9807-9172","authenticated-orcid":false,"given":"Eelco F M","family":"Wijdicks","sequence":"first","affiliation":[{"name":"Division of Neurocritical Care and Hospital Neurology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,9,19]]},"reference":[{"key":"2025090409322542000_20.1.26.1","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1111\/ene.13572","article-title":"How often is the diagnosis of the permanent vegetative state incorrect? 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