Incidence and prevalence of coma in the UK and the USA

Author:

Kondziella Daniel12ORCID,Amiri Moshgan1,Othman Marwan H1,Beghi Ettore3,Bodien Yelena G45,Citerio Giuseppe67,Giacino Joseph T4,Mayer Stephan A8,Lawson Thomas N9,Menon David K10ORCID,Rass Verena11,Sharshar Tarek1213,Stevens Robert D141516,Tinti Lorenzo3,Vespa Paul1718,McNett Molly9,Venkatasubba Rao Chethan P19,Helbok Raimund11ORCID,Akbari Yama,Boly Melanie,Dangayach Neha,Edlow Brian,Foreman Brandon,Gilmore Emily,Hammond Flora M,Hemphill J Claude,Human Theresa,Madden Lori Kennedy,Mainali Shraddha,Meyfroidt Geert,Monti Martin,Nakase-Richardson Risa,Nyquist Paul,Olson DaiWai,Park Soojin,Provencio Jose Javier,Puybasset Louis,Sarwal Aarti,Shutter Lori,Witherspoon Briana,Whyte John,Ziai Wendy,

Affiliation:

1. Department of Neurology, Rigshospitalet, Copenhagen University Hospital , Blegdamsvej 9 , DK-2100 Copenhagen, Denmark

2. Department of Clinical Medicine, University of Copenhagen , Copenhagen 2100 , Denmark

3. Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS , Milan 20156 , Italy

4. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School , Boston, MA 02115 , USA

5. Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, MA 02114 , USA

6. NeuroIntensive Care, ASST di Monza , Monza 20900 , Italy

7. School of Medicine and Surgery, Università Milano Bicocca , Milan 20100 , Italy

8. Department of Neurology, New York Medical College , Valhalla, NY 10595 , USA

9. College of Nursing, The Ohio State University , Columbus, OH 43210 , USA

10. Division of Anaesthesia, University of Cambridge , Cambridge CB2 2QQ , UK

11. Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck , Innsbruck 6020 , Austria

12. Neuro-anesthesiology and Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University , Paris 75006 , France

13. Experimental Neuropathology, Infection and Epidemiology Department, Institut Pasteur , Paris 75015 , France

14. Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine , Baltimore, MD 21287 , USA

15. Department of Neurology, The Johns Hopkins University School of Medicine , Baltimore, MD 21218 , USA

16. Department of Neurosurgery, The Johns Hopkins University School of Medicine , Baltimore 21287, MD , USA

17. Department of Neurology, David Geffen School of Medicine at UCLA , Los Angeles, CA 90095 , USA

18. Department of Neurosurgery, David Geffen School of Medicine at UCLA , Los Angeles, CA 90095 , USA

19. Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine and CHI Baylor St Luke's Medical Center , Houston, TX 77030 , USA

Abstract

Abstract The epidemiology of coma is unknown because case ascertainment with traditional methods is difficult. Here, we used crowdsourcing methodology to estimate the incidence and prevalence of coma in the UK and the USA. We recruited UK and US laypeople (aged ≥18 years) who were nationally representative (i.e. matched for age, gender and ethnicity according to census data) of the UK and the USA, respectively, utilizing a crowdsourcing platform. We provided a description of coma and asked survey participants if they—‘right now’ or ‘within the last year’—had a family member in coma. These participants (UK n = 994, USA n = 977) provided data on 30 387 family members (UK n = 14 124, USA n = 16 263). We found more coma cases in the USA (n = 47) than in the UK (n = 20; P = 0.009). We identified one coma case in the UK (0.007%, 95% confidence interval 0.00–0.04%) on the day of the survey and 19 new coma cases (0.13%, 95% confidence interval 0.08–0.21%) within the preceding year, resulting in an annual incidence of 135/100 000 (95% confidence interval 81–210) and a point prevalence of 7 cases per 100 000 population (95% confidence interval 0.18–39.44) in the UK. We identified five cases in the USA (0.031%, 95% confidence interval 0.01–0.07%) on the day of the survey and 42 new cases (0.26%, 95% confidence interval 0.19–0.35%) within the preceding year, resulting in an annual incidence of 258/100 000 (95% confidence interval 186–349) and a point prevalence of 31 cases per 100 000 population (95% confidence interval 9.98–71.73) in the USA. The five most common causes were stroke, medically induced coma, COVID-19, traumatic brain injury and cardiac arrest. To summarize, for the first time, we report incidence and prevalence estimates for coma across diagnosis types and settings in the UK and the USA using crowdsourcing methods. Coma may be more prevalent in the USA than in the UK, which requires further investigation. These data are urgently needed to expand the public health perspective on coma and disorders of consciousness.

Funder

Neurocritical Care Society

Novo Nordisk Foundation

Lundbeck Foundation

Offerfonden

National Institute of Neurological Disorders and Stroke

National Institute on Disability, Independent Living and Rehabilitation Research

Administration for Community Living

James S. McDonnell Foundation

Tiny Blue Dot Foundation

Publisher

Oxford University Press (OUP)

Subject

General Earth and Planetary Sciences,General Environmental Science

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