Should the general practitioner be prepared for the patient with decreased consciousness or coma?

Data are scarce about the possible role for the general practitioner (GP) in patients with decreased consciousness (DC) or coma. We wanted to investigate how often a GP is confronted with DC or coma during out-of-hours service in an urban region and to compare the patients presented to primary care to those who were immediately treated by the emergency medical services (EMS).

In a prospective observational study during 2 weekends in the city of Ghent, Belgium, which has 232 500 inhabitants, 724 patients were seeking emergency care, and DC or coma was the reason for encounter in 27 patients (3.8%). Eight patients initially seen by a GP had more heterogeneous diagnoses than the 19 patients immediately transferred to the emergency department without intervention by a GP.

This study shows that about one-third (N=8) of emergencies involving patients with DC or coma were initially evaluated by a GP; five out of these eight patients were subsequently transported by the EMS. We conclude that telephone triage guidelines providing simultaneous alerts of the GP and the EMS for DC or coma patients, tailored training of GPs with skills maintenance, adequate equipment and close collaboration with the EMS are recommended for GP out-of-hours services.