Evidence map›Paper›PMID 42059919›Full record

ReviewIntensive care medicine2026

Stepwise clinical and diagnostic strategy for coma of unknown origin.

Stein Silva, Miriam Treggiari, Giuseppe Citerio, Robert David Stevens, Marzia De Lucia, Virginia Newcombe, Aurore Thibaut, Nicolas Weiss, Romain Sonneville

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Intensive care medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
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

1 citing paper in PubMed.

  1. How we use the neurological pupil index (NPi).Critical care (London, England) · 2026
    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

9 authors.

Stein SilvaUniversity of Toulouse, INSERM, ToNIC, TRACER team, Toulouse, France. stein.silva@inserm.fr.ORCID http://orcid.org/0000-0001-9690-7413
Miriam TreggiariDepartment of Anesthesiology, Duke University Medical Center, Durham, USA.
Giuseppe CiterioSchool of Medicine and Surgery, University Milano- Bicocca, Milano, Italy.
Robert David StevensDepartment of Anesthesiology and Critical Care, John Hopkins University School of Medicine, Baltimore, USA.
Marzia De LuciaBrain-Body and Consciousness Laboratory, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Virginia NewcombeDepartment of Medicine, University of Cambridge, Cambridge, UK.
Aurore ThibautGIGA Neuroscience, GIGA Institute, University of Liège, Liège, Belgium.
Nicolas WeissNeurological Intensive Care Unit, Neurology Department, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
Romain SonnevilleDepartment of Intensive Care Medicine, Université Paris Cité, INSERM U1137, IAME, APHP.Nord, Bichat-Claude Bernard University Hospital, Paris, France.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Coma represents a critical failure of brain systems regulating arousal and awareness, posing significant diagnostic challenges when its origin is unknown. Accurate and timely diagnosis is essential to identify reversible causes and guide treatment. Here, we propose a comprehensive stepwise diagnostic algorithm integrating clinical examination, electroencephalography, neuroimaging, and laboratory investigations, emphasizing iterative reassessment to inform early decision-making. This approach, grounded in the pathophysiology of coma and current consciousness frameworks, facilitates localization of brain dysfunction and prioritizes detection of treatable etiologies. Emerging neurotechnologies, including advanced MRI and multimodal AI, hold promise for enhancing diagnosis and personalized management. Our framework aims to improve clinical outcomes by promoting systematic, physiology-based evaluation of coma of unknown origin in acute-care settings.

Indexed as

ComaAlgorithmsElectroencephalographyHumansMagnetic Resonance ImagingNeuroimagingClinical examination in comaComa pathophysiologyDisorders of consciousnessElectroencephalography (EEG)Neuroimaging in coma

Identifiers

PMID42059919
PMCPMC13221429

What OpenQuestion holds

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Registered trials

None linked

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.