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Related Concept Videos

Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...

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Related Experiment Video

Updated: May 20, 2026

SECONDs Administration Guidelines: A Fast Tool to Assess Consciousness in Brain-injured Patients
11:05

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Published on: February 6, 2021

Metabolic vs structural coma in the ED--an observational study.

Sune Forsberg1, Jonas Höjer, Ulf Ludwigs

  • 1Medical Intensive Care Unit, South Hospital, SE-118 83 Stockholm, Sweden.

The American Journal of Emergency Medicine
|July 17, 2012
PubMed
Summary
This summary is machine-generated.

Young, unconscious patients with low blood pressure and no focal neurological signs likely have a metabolic coma. This can help avoid unnecessary brain imaging in emergency departments.

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Area of Science:

  • Emergency Medicine
  • Neurology
  • Critical Care

Background:

  • Unconscious patients in the emergency department (ED) are typically diagnosed with metabolic or structural conditions.
  • Distinguishing between these two primary causes of coma is crucial for effective treatment.

Purpose of the Study:

  • To identify routinely recorded clinical features that can differentiate between metabolic and structural causes of coma in the ED.
  • To improve diagnostic accuracy and potentially streamline patient management.

Main Methods:

  • Prospective enrollment of 875 adult patients with a Glasgow Coma Scale (GCS) score < 11 in Stockholm (February 2003 - May 2005).
  • Data collection included GCS score and other clinical features recorded within one month of admission.

Main Results:

  • The study identified 633 metabolic (72%) and 242 structural (28%) coma cases.
  • Younger age (<51 years), low/normal blood pressure (<151 mm Hg systolic), and absence of focal neurological signs strongly predicted metabolic coma (96% probability).
  • Metabolic coma had significantly lower hospital mortality (14%) compared to structural coma (56%).

Conclusions:

  • Unconscious young adults presenting without trauma, with low/normal blood pressure, and no focal signs likely have a metabolic disorder.
  • These clinical findings suggest that computed tomography (CT) of the brain may be postponed or avoided in such cases, optimizing resource utilization.