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[Coma in the emergency room].

M Braun1,2, C J Ploner3, T Lindner4

  • 1Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.

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Summary
This summary is machine-generated.

Coma of unknown origin (CUO) requires rapid diagnosis. An interdisciplinary standard operating procedure (SOP) led by neurologists improves patient outcomes by integrating clinical, imaging, and laboratory diagnostics.

Keywords:
Coma of unclear etiologyDiagnostic algorithmNeurological emergencyNon-traumatic comaTreatment guidelines

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Internal Medicine

Background:

  • Coma of unknown origin (CUO) is a critical emergency symptom with high mortality.
  • Diagnosis is challenging due to diverse causes, including central nervous system (CNS) and extracerebral pathologies.
  • Current management lacks standardized guidelines for adult CUO patients.

Purpose of the Study:

  • To introduce an interdisciplinary standard operating procedure (SOP) for acute CUO management.
  • To establish clear triage criteria and an organized in-hospital response system.
  • To emphasize an integrative diagnostic approach for CUO.

Main Methods:

  • Development and implementation of an interdisciplinary SOP in a maximum care hospital.
  • Triage criteria for pre-hospital identification of CUO patients.
  • In-hospital coordination led by neurology, involving internal medicine, anesthesiology, neurosurgery, and trauma surgery.
  • Standardized diagnostics including laboratory tests (CSF, toxicology), CT, and CT angiography (CTA).

Main Results:

  • The SOP facilitates early identification and structured management of CUO.
  • Neurologists and internists are crucial early in the diagnostic work-up.
  • An integrative approach combining clinical examination, imaging, and laboratory testing is superior to syndrome-dependent imaging.
  • Multiple pathologies can coexist and contribute to CUO, necessitating comprehensive evaluation.

Conclusions:

  • The proposed SOP provides a framework for effective CUO management.
  • Early involvement of neurology and internal medicine is vital.
  • An integrative diagnostic strategy is essential for accurate aetiological classification in CUO.