Coma: nontraumatic: most patients died

Clinical bottom line (level 4)

  1. A third of patients in a coma were dead within one hour.
  2. 90% were dead within a year.
  3. Less than 1% made a good recovery.
Levy et al: Annals of Internal Medicine 1981; 94: 293-301
Expires October 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: 3 acute hospitals, USA and UK

500 patients (aged ?, ?% male) admitted in a coma or became comatose after admission

Excluded if
  • coma due to trauma or drugs
  • coma lasted < 6 hours
  • aged < 12




    • 100% followed for 1 year
    Outcomes studied:
  • death within 24 hours
  • death within 1 week
  • death within 1 month
  • death within 6 months
  • death within 1 year
  • good recovery

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death 24 hours 113/500 23%
    (19% to 26%)    		 4
    (4 to 5)
    death 7 days 321/500 64%
    (60% to 68%)    		 2
    (1 to 2)
    death 4 weeks 379/500 76%
    (72% to 80%)    		 1
    (1 to 1)
    death 6 months 435/500 87%
    (84% to 90%)    		 1
    (1 to 1)
    death 12 months 440/500 88%
    (85% to 91%)    		 1
    (1 to 1)
    good recovery 12 months 3/500 0.60%
    (0.0% to 1.3%)    		 170
    (78 to infinity)

    Citation

    1. 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: Malcolm Daniel

    Clinical Question.
    Patient coma
    Intervention or Exposure
    Outcome death or good recovery