Medical Intensive Care Unit, South Hospital, SE-118 83 Stockholm, Sweden.
Am J Emerg Med. 2012 Nov;30(9):1986-90. doi: 10.1016/j.ajem.2012.04.032. Epub 2012 Jul 15.
Patients presenting unconscious may reasonably be categorized as suffering from a metabolic or structural condition.
The objective was to investigate if some routinely recorded clinical features may help to distinguish between these 2 main forms of coma in the emergency department (ED).
Adults admitted to an ED in Stockholm between February 2003 and May 2005 with a Glasgow Coma Scale (GCS) score less than 11 were enrolled prospectively. The GCS score was entered into a protocol that was complemented with available data within 1 month.
The study population of 875 patients was classified into 2 main groups: one with a metabolic (n = 633; 72%) and one with a structural disorder (n = 242; 28%). Among the clinical features recorded in the ED, 3 were found to be strongly associated with a metabolic disorder, namely, young age, low or normal blood pressure, and absence of focal signs in the neurological examination. Patients younger than 51 years with a systolic blood pressure less than 151 mm Hg who did not display signs of focal pathology had a probability of 96% for having a metabolic coma. The mean GCS score on admission was identical in the groups. Hospital mortality was 14% in the metabolic and 56% in the structural group.
These findings indicate that unconscious young adults who present without a traumatic incident with a low or normal blood pressure and without signs of focal pathology most probably suffer from a metabolic disorder, wherefore computed tomography of the brain may be postponed and often avoided.
表现为意识丧失的患者合理地可分为代谢性或结构性疾病。
旨在探讨一些常规记录的临床特征是否有助于在急诊科区分这 2 种主要昏迷形式。
2003 年 2 月至 2005 年 5 月期间，在斯德哥尔摩的急诊科收入格拉斯哥昏迷量表（GCS）评分<11 的成年人前瞻性入组。GCS 评分被输入到一个方案中，该方案在 1 个月内补充了可用数据。
875 例患者的研究人群分为 2 个主要组：代谢组（n=633；72%）和结构障碍组（n=242；28%）。在急诊科记录的临床特征中，有 3 种特征与代谢紊乱密切相关，即年龄较小、血压低或正常、神经系统检查无局灶性体征。年龄小于 51 岁、收缩压<151mmHg 且无局灶性病理体征的患者发生代谢性昏迷的可能性为 96%。入院时的平均 GCS 评分在两组中相同。代谢组的住院死亡率为 14%，结构组为 56%。
这些发现表明，无意识的年轻成年人在无创伤性事件发生时表现为低血压或正常血压且无局灶性病理体征，很可能患有代谢性疾病，因此可能会推迟甚至避免进行脑部计算机断层扫描。
