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Coma occurring in the course of an illness ordinarily implies a poor prognosis and early prognostication is important for treatment decisions. The study was undertaken to study the factors associated with mortality in nontraumatic coma in a tertiary institution.
In this prospective observational study, adults with clinically confirmed coma Glasgow...
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... hundred and sixteen (59.8%) patients presented to the accident and emergency unit of the hospital within 24 h of onset of coma. The predominant etiological factors were central nervous system (CNS) infections which occurred in 56 (28.9%), toxic and metabolic causes in 56 (28.9%), and stroke in 46 (23.7%) [ Table 1]. Stroke was the most common singular etiological factor identifi ed. ...
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Background:
A reliable predictor for early recovery of consciousness in comatose patients is of great clinical significance. Here we aimed to investigate the potentially prognostic value of electroencephalogram-reactivity (EEG-R) in combination with sleep spindles, termed EEG-awakening, for behavioral awakening in etiologically diverse comatose pa...
Citations
... Mortality due to Stroke was observed 83% in Esquevin et al study, 69% in Owolabi et al. study. 3,14 Hypertension (29.66%), Diabetes (15%) were major comorbidities in our study ( Table 4,5). ...
... The frequency of toxic coma varies in different studies, from 5% [26] to 28.9% [27]. In a recent prospective observational study, they accounted for 11.5% of all nontraumatic coma [28]. ...
... In GCS -3, the mortality was 58% and it was proportionately in decreasing order with corresponding increasing GCS score. The same is reported in almost all earlier studies and Meta analysis [1][2][3][4][5][6]9 The mortality was significantly more in those cases who reported to hospital after 24 hours of onset of Coma (68%) while it was 32% in those who reported within 24 hours. Many previous studies suggested that duration of presentation to hospital of coma patient has significant negative correlation with mortality. ...
... The predictors of mortality in the acute phase in patients suffering from ischemic stroke have been attributed to a variety of parameters available in clinical practice. These parameters are: clinical as poor GCS [13][14][15], biological such as interleukin-1 (IL 1), IL 6, tumor necrosis factor (TNF), fibrinogen, C reactive protein (CRP), Hematocrit and ESR [7 -12] and radiological as size and site of lesion [16,17]. In this study carried out in an urban setting of Central Africa, the GCS was 10 ± 2.4 in died patients and was significaly lower compared to survival patients with 12 ± 2.2 (p=0.01). ...
... On univariate analysis, poor GCS was associated with mortality (p=0.001) but it wasn't seen on multiple logistic regression analysis. Low Glasgow score has been reported by African authors as a clinical factor associated with mortality in patients suffering from stroke [14,15,18,19] and by others [20,21]. The ESR, a cellular response to ischemic stroke was found higher (64 ± 24 mm/h) in died patient from acute cerebral infarction (p=0.001). ...
Background: Stroke a major public health problem, its management remains a challenge for the medical professionals. We investigated the clinical, simple biological and tomographic determinants of outcome in patients suffering of ischemic stroke.
Materials and methods: This prospective study was conducted at Kinshasa university hospital from January 2011 to June 2014. A total of 104 consecutive patients with first-ever ischemic stroke confirmed by computed tomography examination were enrolled for the study. The parameters of interest were clinical, routine biochemical and radiological data within the 3 first days of symptom onset. Logistic regression was used to identify independent determinants of mortality risk.
Results: The average age of patients was 62 ± 14 years old with 68% of male. Among the 22 patients (21%) who died, in univariate analysis, factors associated with lethality were the Glasgow score 40 mm/1h, higher leukocytosis > 10.000 elements/mm3 and non-lacunar brain infarct. On multiple logistic regression analysis, higher elevated erythrocyte sedimentation rate (OR 1.8; 95% CI 1.22 to 89.35; p=0.032), lesion located in infra-tentorial area (OR 4.7; 95% CI 1.30 to 16.38; p=0.017) and hemorrhagic infarct (OR 10.6; 95% CI 2.21 to 77.89; p=0.005) were essentially independent determinants of ischemic stroke mortality.
Conclusion: The study seems to determine factors associated with mortality in patients suffering from cerebral infarction. Glasgow score and routine biomarkers may be useful in low setting area to assess mortality in ischemic stroke patient.
... The prevalence of different causes varied greatly between studies. Infections, including central nervous system infections, were more prevalent in the African studies compared to the other included studies, 10-51% and 2-9% respectively [10][11][12][13]. Additionally, Owolabi et al. reported HIV related coma in 4% of patients in their cohort and Matuja et al. reported a high prevalence of cerebral malaria (40%), while none of the other studies reported on these etiologies as cause of coma [11,12]. ...
... Infections, including central nervous system infections, were more prevalent in the African studies compared to the other included studies, 10-51% and 2-9% respectively [10][11][12][13]. Additionally, Owolabi et al. reported HIV related coma in 4% of patients in their cohort and Matuja et al. reported a high prevalence of cerebral malaria (40%), while none of the other studies reported on these etiologies as cause of coma [11,12]. ...
... Patients with stroke had the highest mortality (60-95%), followed by patients with post-anoxic coma (54-89%) ( Table 3). In contrast, the lowest mortality was found for poisoning and epilepsy: 0-7% and 0-10%, respectively and 35-67% for poisoning in the African studies [8,[10][11][12][13]16,18]. ...
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.
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.
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%).
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.
Introduction: Adult subjects who are a comatose present challenge to the treating healthcare professionals in Indian subjects. Prompt and proper handling of these subjects is vital to attain favorable outcomes. Attaining the diagnosis based on the etiology is vital to handle these subjects properly. Aims: The present study was conducted to assess the immediate outcomes and etiology of comatose adult subjects in Indian settings. Methods: The present prospective and observational clinical study included 150 adult comatose subjects admitted for etiologies other than non-traumatic cases and GCS of less than/equal to 10 in the Indian healthcare center. In malignancy cases, 1.49% (n=1) subject died, whereas, 3.61% (n=3) subjects survived, in snake bite 5.97% (n=4) subjects died and 4.81% (n=4) subjects survived, in infection, 7.46% (n=5) subjects died and 19.27% (n=16) subjects survived, in metabolic cause, 13.43% (n=9) subjects died and 40.96% (n=34) subjects survived, and in stroke as etiology, 71.64% (n=48) subjects died and 31.32% (n=26) subjects survived. Based on GCS scores, 30% (n=45) subjects had GCS score of 3-6 where 56.71% (n=38) subjects died and 8.43% (n=7) subjects survived, whereas, there were 70% (n=105) subjects with GCS score of 7-10 where 43.28% (n=29) subjects died and 91.56% (n=76) subjects survived.
Nontraumatic coma (NTC) is a considerable cause of morbidity and mortality in children. This prospective observational study aimed to determine the clinico-etiological profile of NTC in children and delineate clinical signs predicting mortality in Upper Egypt from June 2019 to May 2020. All children from 1 month of age to 16 years who were admitted with NTC were included in the study. All patients received full histories and physical examinations, including Glasgow Coma Scale (GCS). Routine laboratory investigations including complete blood count, electrolytes, blood sugar, serum creatinine, and liver function tests were performed for all patients. Specific investigations such as metabolic studies, lumbar punctures, brain computed tomography scans, and magnetic resonance imaging were done when indicated. The precise etiology was determined and clinical presentations for survivors and nonsurvivors were compared. Among the 137 cases of NTC identified, central nervous system (CNS) infections were the most common cause leading to 38 cases, followed by toxic causes in 37 cases, status epilepticus in 22 cases, and metabolic causes in 21 cases. Hypothermia, hypotension, abnormal respiratory patterns, muscle hypotonia, absent corneal reflex, presence of shock, and need for mechanical ventilation were significantly correlating with mortality. The estimated mortality rate was 18.2% and all cases with GCS < 5 died. Toxic causes were the most commonly identified etiology in patients who died. In conclusion, the authors identified several etiologies for NTC in Upper Egypt and their corresponding clinical signs at presentation. This information can be used to improve the clinical care provided to children with NTC.
Background
Metabolic encephalopathy (ME), central nervous system (CNS) infections, and stroke are common causes of reduced level of consciousness in Uganda. However, the prognostic utility of changes in the daily measurements of the Full Outline of Unresponsiveness (FOUR) score and Glasgow Coma Scale (GCS) score in these specific disorders is not known.Methods
We conducted secondary analyses of data from patients who presented with reduced level of consciousness due to CNS infections, stroke, or ME to a tertiary hospital in Uganda. Patients had FOUR/GCS scores at admission and at 24 and 48 h. We calculated a change in FOUR score (ΔFOUR) and change in GCS score (ΔGCS) at 24 and 48 h and used logistic regression models to determine whether these changes were predictive of 30-day mortality. In addition, we determined the prognostic utility of adding the admission score to the 24-h ΔFOUR and 24-h ΔGCS on mortality.ResultsWe analyzed data from 230 patients (86 with ME, 79 with CNS infections, and 65 with stroke). The mean (SD) age was 50.8 (21.3) years, 27% (61 of 230) had HIV infection, and 62% (134 of 230) were peasant farmers. ΔFOUR at 24 h was predictive of mortality among those with ME (odds ratio [OR] 0.64 [95% confidence interval {CI} 0.48–0.84]; p = 0.001) and those with CNS infections (OR 0.65 [95% CI 0.48–0.87]; p = 0.004) but not in those with stroke (OR 1.0 [95% CI 0.73–1.38]; p = 0.998). However, ΔGCS at 24 h was only predictive of mortality in the ME group (OR 0.69 [95% CI 0.56–0.86]; p = 0.001) and not in the CNS or stroke group. This 24-h ΔGCS and ΔFOUR pattern was similar at 48 h in all subgroups. The addition of an admission score to either 24-h ΔFOUR or 24-h ΔGCS significantly improved the predictive ability of the scores in those with stroke and CNS infection but not in those with ME.Conclusions
Twenty-four-hour and 48-h ΔFOUR and ΔGCS are predictive of mortality in Ugandan patients with CNS infections and ME but not in those with stroke. For individuals with stroke, the admission score plays a more significant predictive role that the change in scores.
INTRODUCTION Determination of the degree of depression of consciousness in patients with brain damage upon admission to the intensive care unit and intensive therapy is a primary task. In order to carry out a quick and at the same time sufficiently complete assessment of this kind, in 1974 neurosurgeons Graham Teasdale and Bryan Jennett from the University of Glasgow developed an algorithm consisting of a sequential series of tests in the form of eye opening, speech and motor responses, called Glasgow Coma Scale. This scale has received worldwide recognition and for many decades has been the main one for determining the state of consciousness in the most severe patients with brain damage. The absence of a validated version of this scale complicates its application in Russia, and the use of currently available versions that have not passed all the necessary stages of validation distorts the originally intended meaning of the scale and does not allow obtaining reliable clinical results when examining patients with acute impairment of consciousness.
AIM OF STUDY Development of the official Russianlanguage version of the Glasgow Coma Scale, taking into account linguistic and cultural characteristics (1st stage of the validation study).
MATERIAL AND METHODS The staff of Center for Validation of Health Status Questionnaires and Scales in Russia, Research Center of Neurology obtained consent from G. Teasdale to validate Glasgow Coma Scale in Russia. Two Russianspeaking professional certified translators in the field of medicine performed a direct translation of the original Englishlanguage scale, and a reverse translation was carried out by native speakers with a medical education. Pilot study was performed in 15 patients with acute impairment of consciousness, two meetings of the expert committee were held (before and after pilot study).
RESULTS Based on the results of the first meeting of the expert commission, a linguistic and cultural adaptation of the text of the scale was carried out. During the pilot testing of the researchers did not have difficulties in understanding and interpreting instructions. As a result, the second meeting of the expert commission was held and the final Russianlanguage version was approved, which is presented in this article and is available on the website of Center for Validation of Health Status Questionnaires and Scales in Russia, Research Center of Neurology.
CONCLUSION For the first time, the Russian language version of the Glasgow Coma Scale was officially presented and recommended for use both in clinical and research practice in Russia and other Russian speaking countries. The next publication will highlight the result of assessing the psychometric properties (reproducibility, interexpert agreement and sensitivity) of the Russianlanguage version of the scale.
