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Kim D, Lee D, Lee J, Lee B, Ko SW. Association between the red cell distribution width and mortality in elderly patients with non-traumatic coma: An observational cohort study. Medicine (Baltimore) 2024; 103:e38773. [PMID: 38941367 DOI: 10.1097/md.0000000000038773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
Elevated red blood cell distribution width (RDW) can be associated with disease severity. However, studies on RDW for the prognosis of elderly patients with non-traumatic coma (NTC) are lacking. This study aims to examine the relationship between RDW and outcomes in elderly patients with NTC. This observational cohort study included elderly patients (aged ≥ 65 years) with NTC between January 2022 and December 2022. We measured RDW upon patient arrival at the emergency department (ED). We conducted a multivariable analysis using logistic regression of relevant covariates to predict in-hospital mortality. Survival curves based on 30-day mortality were designed using the Kaplan-Meier method. The primary outcome was in-hospital mortality, and the secondary outcome was 30-day mortality. A total of 689 patients were included in the study, and in-hospital mortality was 29.6% (n = 204). Our results found that the RDWs of non-survivors were significantly greater than those of survivors (14.6% vs 13.6%). Multivariable analysis showed that RDWs at ED arrival were independently associated with in-hospital mortality (odds ratio, 1.126; 95% confidence interval, 1.047-1.212; P < .001). The Kaplan-Meier curve indicated that the survival probability of patients with a low RDW was greater than those with a high RDW. Having a high RDW at ED arrival was associated with in-hospital mortality in elderly patients with NTC.
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Affiliation(s)
- Dongki Kim
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Donghun Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jiho Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byungkook Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sang Won Ko
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
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2
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Lukić S, Stojanov A. Seizure or syncope: Is the history-based scale feasible to use in an emergency department setting? Australas Emerg Care 2024; 27:142-147. [PMID: 38057243 DOI: 10.1016/j.auec.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND This study aimed to assess the efficacy of a screening questionnaire, based on historical criteria, in distinguishing between seizures and syncope in patients experiencing their first episode of transient loss of consciousness (TLOC) in a neurology emergency department. METHODS A prospective cohort of 159 patients with initial TLOC episodes underwent clinical observation and answered a nine-question screening questionnaire. The questionnaire's predictive ability was compared to final diagnoses determined through detailed neurology, electrophysiology, and cardiology assessments during a minimum 12-month follow-up. Logistic regression (LR) analysis was performed with final diagnosis as the outcome variable. The calibration and discrimination of the models were assessed. RESULTS revealed that the screening score accurately classified 72.33% of patients. Among those with positive screening scores, 65 (67.71%) had seizures compared to 31 (32.29%) with syncope. Introducing a novel risk-scoring model incorporating age and gender, in addition to the screening score, significantly improved performance achieving an accurate classification rate of 81.48%. Among patients with a positive prediction, 63 (80.77%) had seizure, whereas 15 (19.23%) had syncope. CONCLUSIONS Employing a structured questionnaire based on common historical criteria is a valuable tool for distinguishing between seizure and syncope in the dynamic setting of the emergency department.
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Affiliation(s)
- Stevo Lukić
- Clinic of Neurology, University Clinical Centre Niš, Serbia; Faculty of Medicine, University of Niš, Serbia.
| | - Aleksandar Stojanov
- Clinic of Neurology, University Clinical Centre Niš, Serbia; Faculty of Medicine, University of Niš, Serbia
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3
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Moussa BS, Abd Elatiff ZM, Kamal Eldin Elhadary GM. Survey study of the etiology of non-traumatic altered consciousness in the Emergency Department at Suez Canal University Hospital in Egypt. World J Clin Cases 2023; 11:1310-1317. [PMID: 36926139 PMCID: PMC10013117 DOI: 10.12998/wjcc.v11.i6.1310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/06/2023] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Disorders of consciousness including coma in non-trauma patients can be caused by a wide variety of pathologies affecting the central nervous system. They represent a frequent challenge in emergency medicine and are combined with a very high in-hospital mortality. Hence, early treatment of these patients is vital and increases the likelihood of a good outcome.
AIM To identify the causes of altered consciousness presentation to the Emergency Department at Suez Canal University Hospital.
METHODS This was a descriptive cross-sectional study conducted on 87 patients with acute non-traumatic disturbed level of consciousness (DLOC) at the Emergency Department.
RESULTS The mean age of the studied patients was 60.5 ± 13.6 years. Among them, 60% were males and 40% were females. The most common cause of acute non-traumatic DLOC was systemic infection, such as sepsis and septic shock (25.3%), followed by respiratory causes (24.1%) and neurological causes (18.4%).
CONCLUSION The most common cause of acute non-traumatic DLOC was systemic infections followed by respiratory and neurological causes.
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Affiliation(s)
- Bassant S Moussa
- Emergency Medicine Department, Suez Canal University, Faculty of Medicine, Ismailia 41522, Egypt
| | - Zeinab M Abd Elatiff
- Emergency Medicine Department, Suez Canal University, Faculty of Medicine, Ismailia 41522, Egypt
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Barras P, Siclari F, Hügli O, Rossetti AO, Lamy O, Novy J. A potential role of hypophosphatemia for diagnosing convulsive seizures: A case‐control study. Epilepsia 2019; 60:1580-1585. [DOI: 10.1111/epi.16090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/27/2019] [Accepted: 05/27/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Pierre Barras
- Bachelor of Medicine University of Lausanne Lausanne Switzerland
| | - Francesca Siclari
- Center for Investigation and Research on Sleep Lausanne University Hospital Lausanne Switzerland
| | - Olivier Hügli
- Emergency Department Lausanne University Hospital Lausanne Switzerland
| | - Andrea O. Rossetti
- Neurology Service Department of Clinical Neurosciences Lausanne University Hospital Lausanne Switzerland
| | - Olivier Lamy
- Center of Bone Diseases and Service of Internal Medicine Lausanne University Hospital Lausanne Switzerland
| | - Jan Novy
- Neurology Service Department of Clinical Neurosciences Lausanne University Hospital Lausanne Switzerland
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5
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The urgent neurological consultation in the population of the province of Ferrara, Italy. Neurol Sci 2018; 39:1253-1259. [DOI: 10.1007/s10072-018-3424-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
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6
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Braun M, Ploner CJ, Lindner T, Möckel M, Schmidt WU. [Coma in the emergency room]. DER NERVENARZT 2018; 88:607-615. [PMID: 28424823 DOI: 10.1007/s00115-017-0329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Coma of unknown origin (CUO) is a frequent unspecific emergency symptom associated with a high mortality. A fast diagnostic work-up is essential given the wide spectrum of underlying diagnoses that are made up of approximately 50% primary central nervous system (CNS) pathologies and approximately 50% extracerebral, almost exclusively internal medical causes. Despite the high mortality associated with this symptom, there are currently no generally accepted management guidelines for adult patients presenting with CUO. We propose an interdisciplinary standard operating procedure (SOP) for patients with acute CUO as has been established in our maximum care hospital. The SOP is triggered by simple triage criteria that are sufficient to identify CUO patients before arrival in hospital. The in-hospital response team is led by a neurologist. Collaboration with nursing staff, internal medicine, anesthesiology, neurosurgery and trauma surgery is organized along structured pathways that include standardized laboratory tests, including cerebrospinal fluid (CSF), toxicology, computed tomography (CT) and CT angiography imaging (CTA). Our data suggest that neurologists and internists need to be placed at the beginning of the diagnostic work-up. Imaging should not just be carried out depending on the clinical syndrome because sensitivity, specificity and inter-rater reliability of the latter are not sufficient and because in many cases, multiple pathologies can be detected that could each explain CUO alone. Clinical examination, imaging and laboratory testing should be regarded as components of an integrative diagnostic approach and the final aetiological classification should only be made after the diagnostic work-up is complete.
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Affiliation(s)
- M Braun
- Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Centrum für Schlaganfallforschung (CSB), Berlin, Deutschland
| | - C J Ploner
- Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - T Lindner
- Arbeitsbereich Notfallmedizin/Rettungsstellen, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum und Campus Charité Mitte, Berlin, Deutschland
| | - M Möckel
- Arbeitsbereich Notfallmedizin/Rettungsstellen, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum und Campus Charité Mitte, Berlin, Deutschland
| | - W U Schmidt
- Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Centrum für Schlaganfallforschung (CSB), Berlin, Deutschland
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7
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Silva M, Godinho A, Freitas J. Transient loss of consciousness assessment in a University Hospital: From diagnosis to prognosis. Porto Biomed J 2016; 1:118-123. [PMID: 32258560 DOI: 10.1016/j.pbj.2016.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022] Open
Abstract
Background Transient loss of consciousness (TLoC) is a symptom that has several differential etiologic diagnosis, causes significant morbidity and mortality with impact on quality of life. Objective The purpose of this study was to access the diagnosis and prognosis of these patients admitted in a Portuguese University Hospital. Methods The study included 125 patients with TLoC admitted in the emergency room and then admitted to the hospital during the year 2013. Patients were contacted by phone for follow-up evaluations, during the 18 months from the date of admission. Results Cardiogenic syncope was the most common etiology of TLoC (39.2%). The 18-month overall mortality was 11.2%, however this was higher in patients with unexplained TLoC, with an 18-month mortality of 27.8% (p = 0.031); It was found that half of patients who died, did so in the first month from admission date; 20% of patients had recurrent episodes of TLoC (mean number of 5.6 episodes), with a higher percentage of recurrence occurring in patients with reflex syncope (35.3%; p = 0.023). 60% of patients with recurrent episodes suffered accidents and/or injuries, and 20% of recurrence patients gave up driving (p = 0.019). Conclusion The results obtained highlight the burden of TLoC in terms of morbidity and mortality, similar results to those previously published, except for the prevalence of the etiology, cause of death and recurrence's etiology of TLoC. This study emphasizes the significant implications that TLoC leads on morbidity and mortality being essential its accurate diagnosis.
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Affiliation(s)
- Mariana Silva
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
| | - Ana Godinho
- Centro Hospitalar São João, Cardiologia, Porto, Portugal
| | - João Freitas
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal.,Centro Hospitalar São João, Cardiologia, Porto, Portugal
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8
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Braun M, Schmidt WU, Möckel M, Römer M, Ploner CJ, Lindner T. Coma of unknown origin in the emergency department: implementation of an in-house management routine. Scand J Trauma Resusc Emerg Med 2016; 24:61. [PMID: 27121376 PMCID: PMC4848793 DOI: 10.1186/s13049-016-0250-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 04/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coma of unknown origin is an emergency caused by a variety of possibly life-threatening pathologies. Although lethality is high, there are currently no generally accepted management guidelines. METHODS We implemented a new interdisciplinary standard operating procedure (SOP) for patients presenting with non-traumatic coma of unknown origin. It includes a new in-house triage process, a new alert call, a new composition of the clinical response team and a new management algorithm (altogether termed "coma alarm"). It is triggered by two simple criteria to be checked with out-of-hospital emergency response teams before the patient arrives. A neurologist in collaboration with an internal specialist leads the in-hospital team. Collaboration with anaesthesiology, trauma surgery and neurosurgery is organised along structured pathways that include standardised laboratory tests and imaging. Patients were prospectively enrolled. We calculated response times as well as sensitivity and false positive rates, thus proportions of over- and undertriaged patients, as quality measures for the implementation in the SOP. RESULTS During 24 months after implementation, we identified 325 eligible patients. Sensitivity was 60 % initially (months 1-4), then fluctuated between 84 and 94 % (months 5-24). Overtriage never exceeded 15 % and undertriage could be kept low at a maximum of 11 % after a learning period. We achieved a median door-to-CT time of 20 minutes. 85 % of patients needed subsequent ICU treatment, 40 % of which required specialised neuro-ICUs. DISCUSSION Our results indicate that our new simple in-house triage criteria may be sufficient to identify eligible patients before arrival. We aimed at ensuring the fastest possible proceedings given high portions of underlying time-sensitive neurological and medical pathologies while using all available resources as purposefully as possible. CONCLUSIONS Our SOP may provide an appropriate tool for efficient management of patients with non-traumatic coma. Our results justify the assignment of the initial diagnostic workup to neurologists and internal specialists in collaboration with anaesthesiologists.
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Affiliation(s)
- Mischa Braun
- Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.,Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Wolf Ulrich Schmidt
- Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. .,Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Martin Möckel
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Michael Römer
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Christoph J Ploner
- Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tobias Lindner
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
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Forsberg S, Höjer J, Ludwigs U, Nyström H. Metabolic vs structural coma in the ED—an observational study. Am J Emerg Med 2012; 30:1986-90. [DOI: 10.1016/j.ajem.2012.04.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022] Open
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10
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Micieli G, De Falco FA, Consoli D, Inzitari D, Sterzi R, Tedeschi G, Toni D. The role of emergency neurology in Italy: outcome of a consensus meeting for a Intersociety position. Neurol Sci 2011; 33:297-304. [PMID: 22057314 PMCID: PMC3313019 DOI: 10.1007/s10072-011-0841-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/22/2011] [Indexed: 12/03/2022]
Abstract
A possible definition of clinical, educational and organizing aspects of emergency neurology in Italy is reported in this position paper of Emergency Neurology Intersociety Group, created in 2008 among the two neurological Societies in Italy: Società Italiana di Neurologia and Società di Neuroscienze Ospedaliere. The aim of this Group has been the evaluation of the role of neurologist in the emergency setting of Italian hospitals, as well as of the description of different scenarios in which a ward dedicated to a semi-intensive care of neurological emergencies could have a role in the actual organization of academic or general hospitals in our Country. The actual great relevance of neurologist activity in the inpatients treatment, in fact, is actually misleaded as it is the considerable significance of neurological expertise, techniques and support in hospital care pathways also involving neurological manifestations throughout the course of other diseases. Finally, the possible contents of educational programs orienting neurological specialty towards a better comprehension and management of emergency neurological problems either in terms of specific formation or of techniques to be learned by emergency neurologist, are reported as a results of the Consensus Workshop hold in Castiglioncello (LI) in September 12th, 2009.
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Affiliation(s)
- Giuseppe Micieli
- Dipartimento di Neurologia d'Urgenza, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy.
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Martindale JL, Goldstein JN, Pallin DJ. Emergency department seizure epidemiology. Emerg Med Clin North Am 2010; 29:15-27. [PMID: 21109099 DOI: 10.1016/j.emc.2010.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although only 3% of people in the United States are diagnosed with epilepsy, 11% will have at least one seizure during their lifetime. Seizures account for about 1% of all emergency department (ED) visits, and about 2% of visits to children's hospital EDs. Seizure accounts for about 3% of prehospital transports. In adult ED patients, common causes of seizure are alcoholism, stroke, tumor, trauma, and central nervous system infection. In children, febrile seizures are most common. In infants younger than 6 months, hyponatremia and infection are important considerations. Epilepsy is an uncommon cause of seizures in the ED, accounting for a minority of seizure-related visits. Of ED patients with seizure, about 7% have status epilepticus, which has an age-dependent mortality averaging 22%.
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Affiliation(s)
- Jennifer L Martindale
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Boesebeck F, Freermann S, Kellinghaus C, Evers S. Misdiagnosis of epileptic and non-epileptic seizures in a neurological intensive care unit. Acta Neurol Scand 2010; 122:189-95. [PMID: 20003086 DOI: 10.1111/j.1600-0404.2009.01287.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The etiological misinterpretation of paroxysmal neurological symptoms frequently causes a delayed treatment or an inappropriate utilization of ICU-capacities. METHODS In this study, the data of 208 patients admitted to a neurological ICU because of acute transient neurological deficits, loss of consciousness or unclear motor phenomena were retrospectively analyzed. The initial emergency room diagnosis was compared to the final diagnosis and the rate of misdiagnosis was related to the patients' history and diagnostic data. RESULTS In 13.9%, the emergency room diagnosis of epileptic seizures turned out to be incorrect, whereas in 15.6%, the final diagnosis of epileptic seizures was missed in the emergency room. Factors that were significantly correlated to missing the seizure diagnosis were (i) no prior history of epilepsy, (ii) old age, (iii) multi-morbidity, (iv) pathologic CT-scans demonstrating cerebrovascular lesions, (v) seizure description by non-professionals, (vi) predominantly negative seizure phenomena (aphasia, loss of consciousness, paresis), (vii) lack of tongue-bite lesions.
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Affiliation(s)
- F Boesebeck
- University of Muenster, Department of Neurology, Muenster, Germany.
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13
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Martikainen KK, Seppä K, Viita PM, Rajala SA, Luukkaala TH, Keränen T. Outcome and consequences according to the type of transient loss of consciousness: 1-year follow-up study among primary health care patients. J Neurol 2010; 258:132-6. [PMID: 20689962 DOI: 10.1007/s00415-010-5687-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 07/12/2010] [Accepted: 07/20/2010] [Indexed: 11/29/2022]
Abstract
UNLABELLED The prognosis of transient loss of consciousness (LOC) was studied in a one-year follow-up survey. Included were adult patients referred by primary health care physicians for a non-acute specialist consultation during the 2-year period from 01.10.1999 to 30.9.2001. The main outcome measures were recurrence of LOCs during the follow-up, fear of recurrence, injuries, and employment. Altogether, 109 consecutive patients were followed and 39 (36%) suffered a recurrence during the one-year follow-up: 17 (30%) with syncope, 16 (43%) with seizure and six (38%) with uncertain type of LOC. The first ever seizure recurred in 5/9 (56%) during the first year, but only 1 of 17 (6%) first syncope attacks. There was no difference in the recurrence rate if the patient had had previous attacks prior to the index LOC. Injuries, mainly minor, were associated with LOCs in 56% of patients. The risk of injury was highest (83%) with alcohol-related seizures. The unemployment rate was especially high in the seizure group. Fear of recurrence was more common at the beginning than at the end of the follow-up. CONCLUSIONS Seizures recur relatively often, but also recurrent syncope needs more attention--both may cause fear and lead to injuries.
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14
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Prognosis in patients presenting with non-traumatic coma. J Emerg Med 2010; 42:249-53. [PMID: 20542655 DOI: 10.1016/j.jemermed.2010.04.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 01/05/2010] [Accepted: 04/11/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies of patients presenting with coma are limited, and little is known about the prognosis of these cases. OBJECTIVE The aim of this study was to investigate the acute and long-term prognosis after an episode of non-traumatic coma. METHODS Adults admitted consecutively to an emergency department in Stockholm, Sweden between February 2003 and May 2005 with a Glasgow Coma Scale (GCS) score of 10 or below were enrolled prospectively. All available data were used to explore the cause of the impaired consciousness on admission. Patients surviving hospitalization were followed-up for 2 years regarding survival. RESULTS The final study population of 865 patients had the following eight different coma etiologies: poisoning (n = 329), stroke (n = 213), epilepsy (n = 113), circulatory failure (n = 60), infection (n = 56), metabolic disorder (n = 44), respiratory insufficiency (n = 33), and intracranial malignancy (n = 17). The hospital mortality rate among the 865 patients was 26.5%, varying from 0.9% for epilepsy to 71.7% for circulatory failure. The accumulated total 2-year mortality rate was 43.0%, varying from 13.7% for poisoning to 88.2% for malignancy. The level of consciousness on admission also influenced the prognosis: a GCS score of 3-6 was associated with a significantly higher hospital mortality rate than a GCS score of 7-10. CONCLUSION The prognosis in patients presenting with non-traumatic coma is serious and depends largely on both the level of consciousness on admission and the etiology of the coma. Adding the suspected coma etiology to the routine coma grading of these emergencies may more accurately predict their prognosis.
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15
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Abstract
Episodes of transient loss of consciousness (TLOC) events pose diagnostic difficulties, as the causes are diverse, carry vastly different risks, and span various specialties. An inconsistent terminology contributes to the confusion. Here, we present a classification scheme for TLOC, based on ongoing multidisciplinary efforts including those of the Task Force on Syncope of the European Society of Cardiology. We also discuss the pathophysiology of TLOC and the key clinical features that aid diagnosis. TLOC is defined as an apparent loss of consciousness with an abrupt onset, a short duration, and a spontaneous and complete recovery. Syncope is defined as TLOC due to cerebral hypoperfusion, and is divided into reflex syncope (synonymous with neurally mediated syncope), syncope due to orthostatic hypotension, and cardiac syncope (arrhythmic or associated with structural cardiac disease). The other major groups of TLOC are generalized epileptic seizures, functional TLOC (psychogenic TLOC mimicking either epilepsy or syncope), and a further group of miscellaneous disorders. The management of patients who experience TLOC requires the recognition of the defining features of each of the major groups, and cooperation between different clinical specialties.
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16
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The neurologist in the emergency department. An Italian nationwide epidemiological survey. Neurol Sci 2008; 29:67-75. [PMID: 18483703 DOI: 10.1007/s10072-008-0864-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 02/07/2008] [Indexed: 10/22/2022]
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17
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Aydin MA, Mortensen K, Meinertz T, Schuchert A, Willems S, Ventura R. Correlation of Postural Blood Pressure Test and Head-Up Tilt Table Test in Patients with Vasovagal Syncope. Cardiology 2007; 107:380-5. [PMID: 17284899 DOI: 10.1159/000099056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Accepted: 08/17/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND Vasovagal syncope is triggered by complex cerebral and cardiovascular reflex mechanisms leading to general vasodilatation and bradycardia resulting in cerebral hypoperfusion. METHODS We prospectively studied the correlation of postural blood pressure test (PBT) and head-up tilt table test (TT) in patients with recurrent vasovagal syncope. Sixty-eight patients (37 male, 52.4 +/- 18.6 years) were included in the trial. They were asked to participate in a PBT and a TT. Independent samples t-test, ANOVA and Fisher's exact test were used for statistical analysis. p values <0.05 were considered statistically significant. RESULTS Thirty patients (44%) showed a positive TT and thirty-four patients (50%) had a positive PBT. PBT did not show any correlation with TT, although pathophysiological mechanisms in vasovagal syncope and orthostatic hypotension are supposed to be similar. Furthermore neither TT nor PBT nor their combination had any predictive value for the patient's risk of syncope recurrence. CONCLUSIONS TT and PBT are not correlated with each other. Both investigations cannot predict the patient's risk of syncope recurrence.
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Affiliation(s)
- Muhammet Ali Aydin
- Department of Cardiology, Heart Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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18
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Nilsen P, Aalto M, Bendtsen P, Seppä K. Effectiveness of strategies to implement brief alcohol intervention in primary healthcare. A systematic review. Scand J Prim Health Care 2006; 24:5-15. [PMID: 16464809 DOI: 10.1080/02813430500475282] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To review systematically the available literature on implementation of brief alcohol interventions in primary healthcare in order to determine the effectiveness of the implementation efforts by the health are providers. KEY QUESTION: To what extent have the efforts to implement brief alcohol interventions in primary healthcare environments been successful? METHOD Literature search from Medline, Cinahl, PsychLIT, Cochrane. SETTING Primary healthcare. MATERIAL A total of 11 studies encompassing 921 GPs, 266 nurses, 88 medical students, and 44 "non-physicians" from Europe, the USA, and Australia. MAIN OUTCOME MEASURES Material utilization, screening, and brief intervention rates. ANSWER Intervention effectiveness (material utilization, screening, and brief intervention rates) generally increased with the intensity of the intervention effort, i.e. the amount of training and/or support provided. Nevertheless, the overall effectiveness was rather modest. However, the studies examined were too heterogeneous, not scientifically rigorous enough, and applied too brief follow-up times to provide conclusive answers.
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Affiliation(s)
- Per Nilsen
- Department of Health and Society, Division of Social Medicine and Public Health Science, Linköping University, Sweden
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Martikainen K, Seppä K, Viita P, Rajala S, Laippala P, Keränen T. Transient loss of consciousness with and without injuries: where to treat these patients? Eur J Gen Pract 2004; 9:91-5. [PMID: 14712906 DOI: 10.3109/13814780309160411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Transient loss of consciousness (LOC) is a fairly common phenomenon and frequently carries a risk of injury. The aim was to study the occurrence of injuries and causes of emergency referrals versus later specialist consultation in association with LOC in the primary healthcare setting. METHODS A four-month survey was carried out in the Primary Healthcare Emergency Department of the City of Tampere, Finland (198,000 inhabitants). The subjects comprised consecutive patients aged at least 15 years, attending a primary healthcare emergency department because of LOC. The type of LOC was determined (seizure, syncope and uncertain) and the type and site of all injuries associated with LOC were registered. All referrals to hospital or specialist consultation because of LOC were also registered and the predictors of admission were analysed by logistic regression modelling. RESULTS Injury was associated with 43 (20%) out of 220 visits because of LOC; in 12/72 (17%) cases with syncope, in 24/118 (20%) with seizures and in 7/30 (23%) with an uncertain cause of LOC. Most of the injuries were minor. Emergency referral was required in 45/220 (20%) cases of LOC. Coronary heart disease and injury were the main predictors of emergency referral to hospital. CONCLUSIONS Injuries are as frequent in patients with syncope as in those suffering seizures. Most patients with LOC in primary healthcare emergency departments do not seem to require emergency admission to hospital.
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