• E Oschatz, A Bur, W Lang, J Kofler, H Herkner, M Müllner, M Barrientos, C Woisetschläger, O Wagner, E Schindler, and A N Laggner.
• Abteilung für Notfallmedizin, Universitätskliniken, Allgemeines Krankenhaus Wien, Osterreich.
• Wien. Klin. Wochenschr. 1997 Dec 23; 109 (24): 949-53.

ObjectiveEvaluation of the applicability of a protocol designed for the quick and efficient management of patients with coma of unknown origin (CUO).MethodsEvery patient admitted to our Emergency Department with the diagnosis of CUO was evaluated with our diagnostic protocol. The first diagnostic steps included evaluation of the hemodynamic and respiratory situation, Glasgow Coma Scale, basic neurologic and clinical examination, as well as blood withdrawal, for analysis of metabolic and toxicologic parameters. If indicated, cranial computer tomography (CCT) and/or lumbar puncture were performed.ResultsWithin the study period from 1. 1. 1995 until 30. 9. 1996, 122 patients (65 males, median age 50 years, 25 and 75 percentile: 33; 69) were included. Blood analysis and the toxicological screening were diagnostic effective in 66 patients, clinical examination and body temperature in one case each, CCT in 50 patients and lumbar puncture in 2 patients. By the use of this diagnostic protocol 51 neurologic, 38 toxicologic, 28 metabolic and 2 infectious causes of coma were diagnosed (98%). Etiology of 2 of the comas remained unclear.ConclusionBy using our protocol, 98% of the causes of CUO were clarified. The main causes of coma were of neurological, toxicological and metabolic origin. CCT and the blood analysis were the most important procedures leading to a final diagnosis.

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