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Unconscious Patient: Why?


--emergency medicine puzzle: find the cause of coma or impaired consciousness
--cohort of 938 patients with a Glasgow Coma Scale (GCS) score of 10 or below
--most common cause of unconsciousness: poisoning
--poisoning: 38% of all cases and 80% in those under 40 years of age
--over 60 years only 11% were poisoned
--median GCS score on admission was identical (btw poison & non)
--poisoned pts mortality rate: 2.8% (in hospital)
--non-poisoned mort rate: 39%
--2% have neurological sequelae at discharge
--39% (of all) and 18% (under 40) have neuro sequelae of non-poisoned patients
--352/938 were poisoned
--586/938 not poisoned
--of those 586 not poisoned:
----24% focal neurological lesion
----21% metabolic or diffuse cerebral disturbance
----12% epileptogenic
----1% psychogenic
----4% still unDXed at discharge
--researcher: Forsberg
--Emergency Medicine Journal 2009;26:100-102; doi:10.1136/emj.2007.054536
--article title: Coma and impaired consciousness in the emergency room: characteristics of poisoning versus other causes

SOURCE:
http://emj.bmj.com/cgi/content/short/26/2/79?rss=1
http://emj.bmj.com/cgi/content/abstract/26/2/100?ijkey=a9e45a3a31863cf5f848162a844b833e69ba95ff&keytype2=tf_ipsecsha

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