Coma: nontraumatic: the commonest causes were hypoxic-ischaemic and stroke.

Clinical bottom line (level 4)

The commonest causes of nontraumatic coma were hypoxic-ischaemic coma (mainly from cardiac arrest), brain infarcts or haemorrhages and metabolic disorders.

Expires October 2003

The study

Setting: three acute hospitals, USA and UK

500 patients (aged ?, ?% male) admitted in a coma or become comatose during hospital admission

Final diagnosis was made on the basis of clinical and laboratory data. Autopsy results were available in many cases.

The evidence

differential diagnosis	number of patients	prevalence (95% CI)
hypoxia-ischaemia	210	42% (38% to 46%)
cardiac arrest	150	30% (26% to 34%)
brain infarct	76	15% (12% to 18%)
brain haemorrhage	67	13% (10% to 16%)
hepatic encephalopathy	51	10% (7.5% to 13%)
subarachnoid haemorrhage	38	7.6% (5.3% to 9.9%)
other metabolic disturbances	19	3.8% (2.1% to 5.5%)
infection	16	3.2% (1.7% to 4.7%)
isolated disorders like hypoglycaemia	12	2.4% (1.1% to 3.7%)
mass lesions	11	2.2% (0.9% to 3.5%)

Citation

Levy DE, Bates D, Caronna JJ, et al: Prognosis in nontraumatic coma.. Annals of Internal Medicine 1981; 94: 293-301

Contributor: Chris Ball and Clare Wotton, October 1999
Reviewer:

_{Clinical Question.}