Evidence map›Paper›PMID 38366071›Full record

ArticleJournal of neurology2024

Characterizing coma in large vessel occlusion stroke.

Michael J Young, Amine Awad, Alexander Andreev, Anna K Bonkhoff, Markus D Schirmer, Adam A Dmytriw, Justin E Vranic, James D Rabinov, Omer Doron, Christopher J Stapleton and 6 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
1.9field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 5 citations in OpenAlex.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 2 institutions in 1 country.

Michael J YoungDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA. michael.young@mgh.harvard.edu.ORCID http://orcid.org/0000-0001-6661-0811
Amine AwadDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA.
Alexander AndreevDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Anna K BonkhoffDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA.
Markus D SchirmerDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA.
Adam A DmytriwDepartment of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Justin E VranicDepartment of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
James D RabinovDepartment of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Omer DoronDepartment of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Christopher J StapletonDepartment of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Alvin S DasDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA.
Brian L EdlowDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA.
Aneesh B SinghalDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA.
Natalia S RostDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA.
Aman B PatelDepartment of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Robert W RegenhardtDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA.
Harvard University · USBeth Israel Deaconess Medical Center · US

Funding

A Connectome-Based Clinical Trial Platform to Promote Early Recovery of Consciousness after Traumatic ComaDP2HD101400 · NICHD · MASSACHUSETTS GENERAL HOSPITAL · PI EDLOW, BRIAN L. · 2019 to 2019
$2.5M
An Ethical Approach to Detecting Covert ConsciousnessF32MH123001 · NIMH · MASSACHUSETTS GENERAL HOSPITAL · PI YOUNG, MICHAEL J · 2020 to 2022
$159k
American Academy of Neurology Palatucci Advocacy AwardNICHD NIH HHS DP2 HD101400NIH BRAIN Initiative F32MH123001NIH Director's Office DP2HD101400NIMH NIH HHS F32 MH123001
6 · The paper itself

Abstract

backgroundComa is an unresponsive state of disordered consciousness characterized by impaired arousal and awareness. The epidemiology and pathophysiology of coma in ischemic stroke has been underexplored. We sought to characterize the incidence and clinical features of coma as a presentation of large vessel occlusion (LVO) stroke.

methodsIndividuals who presented with LVO were retrospectively identified from July 2018 to December 2020. Coma was defined as an unresponsive state of impaired arousal and awareness, operationalized as a score of 3 on NIHSS item 1a.

results28/637 (4.4%) patients with LVO stroke were identified as presenting with coma. The median NIHSS was 32 (IQR 29-34) for those with coma versus 11 (5-18) for those without (p < 0.0001). In coma, occlusion locations included basilar (13), vertebral (2), internal carotid (5), and middle cerebral (9) arteries. 8/28 were treated with endovascular thrombectomy (EVT), and 20/28 died during the admission. 65% of patients not treated with EVT had delayed presentations or large established infarcts. In models accounting for pre-stroke mRS, basilar occlusion location, intravenous thrombolysis, and EVT, coma independently increased the odds of transitioning to comfort care during admission (aOR 6.75; 95% CI 2.87,15.84; p < 0.001) and decreased the odds of 90-day mRS 0-2 (aOR 0.12; 95% CI 0.03,0.55; p = 0.007).

conclusionsIt is not uncommon for patients with LVO to present with coma, and delayed recognition of LVO can lead to poor outcomes, emphasizing the need for maintaining a high index of suspicion. While more commonly thought to result from posterior LVO, coma in our cohort was similarly likely to result from anterior LVO. Efforts to improve early diagnosis and care of patients with LVO presenting with coma are crucial.

Indexed as

ComaIschemic StrokeAgedAged, 80 and overEndovascular ProceduresFemaleHumansMaleMiddle AgedRetrospective StudiesStrokeThrombectomyComaConsciousnessLVONeuroethicsStrokeThrombectomy

Identifiers

PMID38366071
PMCPMC11889655
OpenAlexW4391876218

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.