vestibulo-ocular responses

SUMMARY In 30 comatose head injured patients vestibulo-ocular responses were elicited by caloric stimulation. Inter- and intra-observer agreement of these responses was studied. The responses were shown in the form of a film to ten doctors who classified them into four categories: no reaction, tonic reaction, paradoxical nystagmus and nystagmus. The level of the coefficient Kappa (a chance-corrected measure of interobserver agreement) was 0 50; this is within the range of levels for most components of clinical examination reported in the literature. Severe injury to the head often results in brainstem dysfunction. Whether or not this is the case can be indicated by eye movement. The prognosis in patients with severe head injury depends on age, on degree and duration of impairment of consciousness and brain-stem dysfunction. It is no surprise, therefore, that spontaneous and elicited eye movements have been shown to be of prognostic value in patients with severe head injury.`l- The practical prognostic value of these symptoms depends on the consistency of as-sessment. This can be determined by studying both inter- and intra-observer agreement. The aim of the present study was to determine the inter- and intra-observer agreement in rating vestibulo-ocular responses. Patients and methods Patient population and ocular signs studied Vestibulo-ocular responses were studied in 30 comatose head-injured patients over a period of 18 months, coma be-ing defined as a state ofdepressed consciousness in which the patient does not open his eyes, does not obey commands and does not speak words, irrespective of stimulus. The series is not consecutive, because the main observer (JHB) was not always present and because the film camera was not always available. The responses were studied on the third or fourth da