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A National Survey on Coma Epidemiology, Evaluation, and Therapy in India: Revisiting the Curing Coma Campaign Come Together Survey

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Abstract

Background

The limited representation from developing countries in the original COME TOGETHER survey gave us an impetus to conduct this survey in the Indian subcontinent.

Methods

This cross-sectional online survey was conducted from August through September 2022. Participants were health care physicians caring for patients with coma and disorders of consciousness. Fischer’s exact test or the Mann–Whitney U-test was used to compare respondents who agreed or disagreed with the preestablished coma definition. Fleiss κ values were calculated to assess agreement among respondents. A p value less than 0.05 was considered statistically significant.

Results

The survey was completed by 130 physicians. We found substantial interrater agreement on absence of wakefulness (71.54%; κ = 0.71), Glasgow Coma Score ≤ 8 (78.46%; κ = 0.78), and failure to respond purposefully to visual, verbal, or tactile stimuli (66.15%; κ = 0.66). Reported common etiologies of coma included traumatic brain injury (50.76%), ischemic stroke (30%), and intracerebral hemorrhage (29.23%). The most common clinical assessment tools used for coma included the Glasgow Coma Score (92.3%) and neurological examination (60.8%). Neurological examination was the most common diagnostic tool used (100%), followed by magnetic resonance imaging (89.2%), basic laboratory studies (88.5%), and head computed tomography/angiography (86.9%). Pharmacological interventions used to stimulate arousal in patients with coma were sedation vacation (91.5%), electrolyte/endocrine correction (65.4%), osmotic therapy with mannitol (60%), hypertonic saline (54.6%), modafinil (46.9%), and antidote for drugs (45.4%). Among the nonpharmacological interventions, sensory stimulation (57.7%) was the most commonly used modality. The most common discharge disposition for comatose patients who survived hospitalization were home with or without services (70.0%).

Conclusions

Differences from the global survey were noted regarding the following: traumatic brain injury being the most common etiology of coma in India, more frequent practice of sedation interruption, less frequent use of electroencephalography in India, rare use of pharmacological neurostimulants, and home being the most common discharge disposition in India.

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Acknowledgements

List of Collaborators are Dr Gayatri L Madhavan, Dr Prashanth Prabhu, Dr Sohail Sachdeva, Dr Amlendu Yadav, Dr Ashima Malhotra, Dr Himanshu Sikri, Dr Ankur Luthra, Dr Ratnesh K Shukla, Dr Ripenmeet salhotra, Dr Sanjiv S Bais, Dr Uma Hariharan, Dr Sivakumar M N, Dr Poonam V Bharambe, Dr Indu Kapoor, Dr Seema B Wasnik, Dr Dinesh Chandak, Dr Nivedita D Moulick, Dr S Manikandan, Dr Pramod Sood, Dr Varsha Zanwar, Dr Hariharan M, Dr Ramunaidu Yellapu, Dr Deepali Herode, Dr Sushma Gurav, Dr Jaya Wanchoo, Dr Shruti Sharma, Dr GSUM Rao, Dr Apurba K Borah, Dr Sudeshna Padhi, Dr Anil kumar, Dr Charu Mahajan, Dr Leena A Patil, Dr Suhas Karkamkar, Dr Vasudha Singhal, Dr Reshu G Khanikar, Dr Pragyan K Routray, Dr Shalini Nair, Dr Urvi Shukla, Dr Ria V Malhotra, Dr Hrishikesh Vaidya, Dr Afroz Khan, Dr Abhaya, Dr Khalid Khatib, Dr Subhal Dixit, Dr Sanjay Walke, Dr Vaibhav Rathi, Dr Ravindra Ghawat, Dr Piyush A Dhawad, dr Shrirang Bamne, Dr Prajakta Pote, Dr Upendra K, Dr Reshma, Dr Jayram Navade, Dr Balasaheb D Bande, Dr Milind Mane, Dr Zafer A Khan, Dr Yogesh Rathod, Dr Sudershana Patil, Dr Amol Jadhav, Dr Pravin S Gare, Dr Achal Gaidhar, Dr Pallavi Meshram, Dr Sonika V Makhija, Dr Suhail S Masoom, Dr Gunadhar Padhi, Dr Vitthal S Alane, Dr Tushar Yadav, Dr Anita Mohanty, Dr Amol Kulkarni, Dr Rahul Pingle, Dr Khusrav Bajan, Dr Sudhir Deshpande, Dr Kapil Zirpe, Dr Baljeet Kaur, Dr Vinay Singhal, Dr Anand Dongre, Dr Ajit K Thakur, Dr Prasad Suryawanshi, Dr Balkrishna Nimavat, Dr Prashant Kumar, Dr Anand Tiwari, Dr Abhijeet Deshmukh, Dr Jignesh Shah, Dr Sridhar, Dr Sharmili Sinha, Dr Sunita A Borade, Dr Ruchira Khasne, Dr Neeta Karmarkar, Dr Abdul S Ansari, Dr Ajit Tambolkar, Dr Santosh Sontakke, Dr Manisha Dhobe, Dr Yash Javeri, Dr Prajakta Lanjewar, Dr S Srinivas, Dr Sunitha Varghese, Dr Deven Juneja, Dr Gunjan Chanchalani, Dr Tadit P Mohanty, Dr Imran Khan, Dr Vivek B Sharma, Dr Suresh Ramasubban, Dr Abhishek Singh, Dr Shradha Gugale, Dr Nidhi Gupta, Dr Gaurav S Tomar, Dr Apurva Kakatkar, Dr Ranvir S Tyagi, Dr N Selvarajan, Dr Ishwar Behera, Dr Raymond D Savio, Dr Jayanti Singh, Dr Ajinkya Bhosle, Dr Gaurav Kakkar, Dr Chaitanya JSK, Dr Jyoti Shendge, Dr Kanwalpreet Sodhi, Dr Pradeep Sharma, Dr S B Mohapatra, Dr Devachandran, Dr Pratheema Ramachandran, Dr Nilesh Sharma, Dr Dona Saha, Dr Rajeev Aggarwal, Dr Raman Piplani, Dr Srikanth, Dr Sathyamurthy G, Dr Naveen Asokumar, Dr Ramchandra V Vinnu, Dr Jyoti Sharma.

Funding

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Author information

Authors and Affiliations

  1. Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, 110029, India

    Charu Mahajan, Hemanshu Prabhakar & Indu Kapoor

  2. Neuro-Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

    Verena Rass

  3. College of Nursing, The Ohio State University, Columbus, OH, USA

    Molly McNett

  4. Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

    Raimund Helbok

  5. Department of Neurology, Johannes Kepler University Linz, Linz, Austria

    Raimund Helbok

  6. Neurotrauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India

    Kapil Zirpe

Authors
  1. Charu Mahajan
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  2. Hemanshu Prabhakar
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  3. Verena Rass
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  4. Molly McNett
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  5. Indu Kapoor
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  6. Raimund Helbok
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  7. Kapil Zirpe
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Consortia

and Collaborators

  • Gayatri L. Madhavan
  • , Prashanth Prabhu
  • , Sohail Sachdeva
  • , Amlendu Yadav
  • , Ashima Malhotra
  • , Himanshu Sikri
  • , Ankur Luthra
  • , Ratnesh K. Shukla
  • , Ripenmeet salhotra
  • , Sanjiv S. Bais
  • , Uma Hariharan
  • , Sivakumar M. N
  • , Poonam V. Bharambe
  • , Indu Kapoor
  • , Seema B. Wasnik
  • , Dinesh Chandak
  • , Nivedita D. Moulick
  • , S. Manikandan
  • , Pramod Sood
  • , Varsha Zanwar
  • , M. Hariharan
  • , Ramunaidu Yellapu
  • , Deepali Herode
  • , Sushma Gurav
  • , Jaya Wanchoo
  • , Shruti Sharma
  • , Gsum Rao
  • , Apurba K. Borah
  • , Sudeshna Padhi
  • , Anil kumar
  • , Charu Mahajan
  • , Leena A. Patil
  • , Suhas Karkamkar
  • , Vasudha Singhal
  • , Reshu G. Khanikar
  • , Pragyan K. Routray
  • , Shalini Nair
  • , Urvi Shukla
  • , Ria V. Malhotra
  • , Hrishikesh Vaidya
  • , Afroz Khan
  • ,  Abhaya
  • , Khalid Khatib
  • , Subhal Dixit
  • , Sanjay Walke
  • , Vaibhav Rathi
  • , Ravindra Ghawat
  • , Piyush A. Dhawad
  • , Shrirang Bamne
  • , Prajakta Pote
  • , K. Upendra
  • ,  Reshma
  • , Jayram Navade
  • , Balasaheb D. Bande
  • , Milind Mane
  • , Zafer A. Khan
  • , Yogesh Rathod
  • , Sudershana Patil
  • , Amol Jadhav
  • , Pravin S. Gare
  • , Achal Gaidhar
  • , Pallavi Meshram
  • , Sonika V. Makhija
  • , Suhail S. Masoom
  • , Gunadhar Padhi
  • , Vitthal S. Alane
  • , Tushar Yadav
  • , Anita Mohanty
  • , Amol Kulkarni
  • , Rahul Pingle
  • , Khusrav Bajan
  • , Sudhir Deshpande
  • , Kapil Zirpe
  • , Baljeet Kaur
  • , Vinay Singhal
  • , Anand Dongre
  • , Ajit K. Thakur
  • , Prasad Suryawanshi
  • , Balkrishna Nimavat
  • , Prashant Kumar
  • , Anand Tiwari
  • , Abhijeet Deshmukh
  • , Jignesh Shah
  • ,  Sridhar
  • , Sharmili Sinha
  • , Sunita A. Borade
  • , Ruchira Khasne
  • , Neeta Karmarkar
  • , Abdul S. Ansari
  • , Ajit Tambolkar
  • , Santosh Sontakke
  • , Manisha Dhobe
  • , Yash Javeri
  • , Prajakta Lanjewar
  • , S. Srinivas
  • , Sunitha Varghese
  • , Deven Juneja
  • , Gunjan Chanchalani
  • , Tadit P. Mohanty
  • , Imran Khan
  • , Vivek B. Sharma
  • , Suresh Ramasubban
  • , Abhishek Singh
  • , Shradha Gugale
  • , Nidhi Gupta
  • , Gaurav S. Tomar
  • , Apurva Kakatkar
  • , Ranvir S. Tyagi
  • , N. Selvarajan
  • , Ishwar Behera
  • , Raymond D. Savio
  • , Jayanti Singh
  • , Ajinkya Bhosle
  • , Gaurav Kakkar
  • , J. S. K. Chaitanya
  • , Jyoti Shendge
  • , Kanwalpreet Sodhi
  • , Pradeep Sharma
  • , S. B. Mohapatra
  • ,  Devachandran
  • , Pratheema Ramachandran
  • , Nilesh Sharma
  • , Dona Saha
  • , Rajeev Aggarwal
  • , Raman Piplani
  • ,  Srikanth
  • , Sathyamurthy G
  • , Naveen Asokumar
  • , Ramchandra V. Vinnu
  •  & Jyoti Sharma

Contributions

CM prepared the first draft of the manuscript and made subsequent changes suggested by coauthors. HP conceived the plan of the study, conducted the survey, analyzed data, and helped in finalizing the draft of the manuscript. VR helped in analyzing data and preparation of the results. MMcN helped in reviewing the results and the manuscript. IK helped in preparation of the manuscript and writing the Discussion. RH reviewed and finalized the manuscript. KZ reviewed the manuscript and gave necessary inputs for the final version of the manuscript.

Corresponding author

Correspondence to Hemanshu Prabhakar.

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Mahajan, C., Prabhakar, H., Rass, V. et al. A National Survey on Coma Epidemiology, Evaluation, and Therapy in India: Revisiting the Curing Coma Campaign Come Together Survey. Neurocrit Care (2023). https://doi.org/10.1007/s12028-023-01852-9

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