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

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 res...

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Autores principales: Horsting, Marlene WB, Franken, Mira D, Meulenbelt, Jan, van Klei, Wilton A, de Lange, Dylan W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424591/
https://www.ncbi.nlm.nih.gov/pubmed/25924678
http://dx.doi.org/10.1186/s12871-015-0041-9
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author Horsting, Marlene WB
Franken, Mira D
Meulenbelt, Jan
van Klei, Wilton A
de Lange, Dylan W
author_facet Horsting, Marlene WB
Franken, Mira D
Meulenbelt, Jan
van Klei, Wilton A
de Lange, Dylan W
author_sort Horsting, Marlene WB
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12871-015-0041-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-44245912015-05-09 The etiology and outcome of non-traumatic coma in critical care: a systematic review Horsting, Marlene WB Franken, Mira D Meulenbelt, Jan van Klei, Wilton A de Lange, Dylan W BMC Anesthesiol Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12871-015-0041-9) contains supplementary material, which is available to authorized users. BioMed Central 2015-04-29 /pmc/articles/PMC4424591/ /pubmed/25924678 http://dx.doi.org/10.1186/s12871-015-0041-9 Text en © Horsting et al.; licensee BioMed Central. 2015 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Horsting, Marlene WB
Franken, Mira D
Meulenbelt, Jan
van Klei, Wilton A
de Lange, Dylan W
The etiology and outcome of non-traumatic coma in critical care: a systematic review
title The etiology and outcome of non-traumatic coma in critical care: a systematic review
title_full The etiology and outcome of non-traumatic coma in critical care: a systematic review
title_fullStr The etiology and outcome of non-traumatic coma in critical care: a systematic review
title_full_unstemmed The etiology and outcome of non-traumatic coma in critical care: a systematic review
title_short The etiology and outcome of non-traumatic coma in critical care: a systematic review
title_sort etiology and outcome of non-traumatic coma in critical care: a systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424591/
https://www.ncbi.nlm.nih.gov/pubmed/25924678
http://dx.doi.org/10.1186/s12871-015-0041-9
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