Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Apr 29:15:65.
doi: 10.1186/s12871-015-0041-9.

The etiology and outcome of non-traumatic coma in critical care: a systematic review

Marlene Wb B Horsting  1 , Mira D Franken  2 , Jan Meulenbelt  3   4 , Wilton A van Klei  5 , Dylan W de Lange  6   7
Affiliations

The etiology and outcome of non-traumatic coma in critical care: a systematic review

Marlene Wb B Horsting et al. BMC Anesthesiol. .

Abstract

Background: Non-traumatic coma (NTC) is a serious condition requiring swift medical or surgical decision making upon arrival at the emergency department. Knowledge of the most frequent etiologies of NTC and associated mortality might improve the management of these patients. Here, we present the results of a systematic literature search on the etiologies and prognosis of NTC.

Methods: Two reviewers independently performed a systematic literature search in the Pubmed, Embase and Cochrane databases with subsequent reference and citation checking. Inclusion criteria were retrospective or prospective observational studies on NTC, which reported on etiologies and prognostic information of patients admitted to the emergency department or intensive care unit.

Results: Eventually, 14 studies with enough data on NTC, were selected for this systematic literature review. The most common causes of NTC were stroke (6-54%), post-anoxic coma (3-42%), poisoning (<1-39%) and metabolic causes (1-29%). NTC was also often caused by infections, especially in African studies affecting 10-51% of patients. The NTC mortality rate ranged from 25 to 87% and the mortality rate continued to increase long after the event had occurred. Also, 5-25% of patients remained moderately-severely disabled or in permanent vegetative state. The mortality was highest for stroke (60-95%) and post-anoxic coma (54-89%) and lowest for poisoning (0-39%) and epilepsy (0-10%).

Conclusion: NTC represents a challenge to the emergency and the critical care physicians with an important mortality and moderate-severe disability rate. Even though, included studies were very heterogeneous, the most common causes of NTC are stroke, post anoxic, poisoning and various metabolic etiologies. The best outcome is achieved for patients with poisoning and epilepsy, while the worst outcome was seen in patients with stroke and post-anoxic coma. Adequate knowledge of the most common causes of NTC and prioritizing the causes by mortality ensures a swift and adequate work-up in diagnosis of NTC and may improve outcome.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Systematic literature search.
See this image and copyright information in PMC

References

    1. Stevens RD, Bhardwaj A. Approach to the comatose patient. Crit Care Med. 2006;34(1):31–41. doi: 10.1097/01.CCM.0000194534.42661.9F. - DOI - PubMed
    1. Kanich W, Brady WJ, Huff JS, Perron AD, Holstege C, Lindbeck G, et al. Altered mental status: evaluation and etiology in the ED. Am J Emerg Med. 2002;20(7):613–7. doi: 10.1053/ajem.2002.35464. - DOI - PubMed
    1. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2((7872):81–4. doi: 10.1016/S0140-6736(74)91639-0. - DOI - PubMed
    1. Edlow JA, Rabinstein A, Traub SJ, Wijdicks EF. Diagnosis of reversible causes of coma. Lancet. 2014;384(9959):2064–76. doi: 10.1016/S0140-6736(13)62184-4. - DOI - PubMed
    1. Wijdicks EF. The bare essentials: coma. Neurol Pract. 2010;10(1):51–60. doi: 10.1136/jnnp.2009.200097. - DOI - PubMed

Publication types