A National Survey on Coma Epidemiology, Evaluation, and Therapy in India: Revisiting the Curing Coma Campaign Come Together Survey
- PMID: 37821721
- DOI: 10.1007/s12028-023-01852-9
A National Survey on Coma Epidemiology, Evaluation, and Therapy in India: Revisiting the Curing Coma Campaign Come Together Survey
Abstract
Background: The limited representation from developing countries in the original COME TOGETHER survey gave us an impetus to conduct this survey in the Indian subcontinent.
Methods: This cross-sectional online survey was conducted from August through September 2022. Participants were health care physicians caring for patients with coma and disorders of consciousness. Fischer's exact test or the Mann-Whitney U-test was used to compare respondents who agreed or disagreed with the preestablished coma definition. Fleiss κ values were calculated to assess agreement among respondents. A p value less than 0.05 was considered statistically significant.
Results: The survey was completed by 130 physicians. We found substantial interrater agreement on absence of wakefulness (71.54%; κ = 0.71), Glasgow Coma Score ≤ 8 (78.46%; κ = 0.78), and failure to respond purposefully to visual, verbal, or tactile stimuli (66.15%; κ = 0.66). Reported common etiologies of coma included traumatic brain injury (50.76%), ischemic stroke (30%), and intracerebral hemorrhage (29.23%). The most common clinical assessment tools used for coma included the Glasgow Coma Score (92.3%) and neurological examination (60.8%). Neurological examination was the most common diagnostic tool used (100%), followed by magnetic resonance imaging (89.2%), basic laboratory studies (88.5%), and head computed tomography/angiography (86.9%). Pharmacological interventions used to stimulate arousal in patients with coma were sedation vacation (91.5%), electrolyte/endocrine correction (65.4%), osmotic therapy with mannitol (60%), hypertonic saline (54.6%), modafinil (46.9%), and antidote for drugs (45.4%). Among the nonpharmacological interventions, sensory stimulation (57.7%) was the most commonly used modality. The most common discharge disposition for comatose patients who survived hospitalization were home with or without services (70.0%).
Conclusions: Differences from the global survey were noted regarding the following: traumatic brain injury being the most common etiology of coma in India, more frequent practice of sedation interruption, less frequent use of electroencephalography in India, rare use of pharmacological neurostimulants, and home being the most common discharge disposition in India.
Keywords: Coma; Critical care; Disorders of consciousness; Survey.
© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
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References
-
- Brogan ME, Provencio JJ. Spectrum of catastrophic brain injury: coma and related disorders of consciousness. J Crit Care. 2014;29(4):679–82. https://doi.org/10.1016/j.jcrc.2014.04.014 . - DOI - PubMed
-
- Glacino JT, Malone R. The vegetative and minimally conscious states. Handb Clin Neurol. 2008;90:99–111. - DOI
-
- Hammond FM, Katta-Charles S, Russell MB, et al. Research needs for prognostic modeling and trajectory analysis in patients with disorders of consciousness. Neurocrit Care. 2021;35(Suppl 1):55–67. https://doi.org/10.1007/s12028-021-01289-y . - DOI - PubMed - PMC
-
- Kondziella D, Menon DK, Helbok R, et al. A precision medicine framework for classifying patients with disorders of consciousness: advanced classification of consciousness endotypes (ACCESS). Neurocrit Care. 2021;35(Suppl 1):27–36. https://doi.org/10.1007/s12028-021-01246-9 . - DOI - PubMed
-
- Luppi AI, Cain J, Spindler LRB, et al. Mechanisms underlying disorders of consciousness: bridging gaps to move toward an integrated translational science. Neurocrit Care. 2021;35(Suppl 1):37–54. https://doi.org/10.1007/s12028-021-01281-6 . - DOI - PubMed - PMC
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