Abstract
BackgroundNon-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.MethodsTwo 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.ResultsEventually, 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%).ConclusionNTC 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-015-0041-9) contains supplementary material, which is available to authorized users.
Highlights
Non-traumatic coma (NTC) is a serious condition requiring swift medical or surgical decision making upon arrival at the emergency department
Nine articles were subsequently excluded as the study only reported on patients with altered mental state (GCS < 15) and not exclusively on patients with Glasgow Coma Scale (GCS) 10 or less, three articles were excluded because no information on mortality and non-traumatic coma (NTC) etiologies was provided, and five articles only reported on a specific coma subgroup
We have shown that the currently studied cohorts hamper thorough conclusion making on the NTC etiology and mortality as the patient cohorts were too heterogeneous
Summary
Non-traumatic coma (NTC) is a serious condition requiring swift medical or surgical decision making upon arrival at the emergency department. We present the results of a systematic literature search on the etiologies and prognosis of NTC. Coma is a serious condition requiring immediate medical decision making upon arrival at the emergency department or intensive care unit (ICU). As coma can originate from many different etiologies and is life threatening, it represents a challenge for emergency or critical care physicians [1]. 5% of the patients present to the emergency department with an Usually, as a first diagnostic step a differentiation is made between traumatic and non-traumatic coma (NTC). In order to make adequate treatment decisions for patients suffering from NTC, it is vitally important to differentiate its etiology. Non-structural coma include coma as a result of poisoning, epilepsy, extracranial infections, circulatory shock, post-anoxic, cardiac arrest, respiratory failure, metabolic problems (such as hypoglycemia, ionic and acid–base disorders, hypothermia), hepatic encephalopathy and uremic encephalopathy [4]
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