Evaluation and Management of Disorders of Consciousness in the Acute Care Setting

Acute disorders of consciousness (DOC) are impairments in arousal and awareness that occur within 28 days of an initial injury and can result from a variety of insults. These states range from coma, unresponsive wakefulness, covert consciousness, minimal consciousness, to confusional state. It is important to perform thorough, serial examinations with particular emphasis on the level of consciousness, brainstem reflexes, and motor responses. Evaluation of acute DOC includes laboratory tests, imaging, and electrophysiology testing. Prognostication in the acute phase of DOC must be done cautiously, using open, frequent communication with families, and by acknowledging significant multidimensional uncertainty.

Automated summary

Acute disorders of consciousness refer to impairments in arousal and awareness that occur within 28 days of an initial injury, which can be caused by various insults. Thorough evaluations, including assessments of consciousness level, brainstem reflexes, and motor responses, are important. Laboratory tests, imaging, and electrophysiology testing are needed for the evaluation of acute disorders of consciousness. Prognostication in this phase should be done cautiously, with open and frequent communication with families, considering the significant multidimensional uncertainty.