State-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist.

Objectives: To provide a concise review of knowledge and practice pertaining to the diagnosis and initial management of unanticipated adult patient disorders of consciousness (DoC) by the general intensivist.
Data Sources: Detailed search strategy using PubMed and OVID Medline for English language articles describing adult patient acute DoC diagnostic evaluation and initial management strategies including indications for transfer.
Study Selection: Descriptive and interventional studies that address acute adult DoC, their evaluation and initial management, indications for transfer, as well as outcome prognostication.
Data Extraction: Relevant descriptions or studies were reviewed, and the following aspects of each manuscript were identified, abstracted, and analyzed: setting, study population, aims, methods, results, and relevant implications for adult critical care practice.
Data Synthesis: Acute adult DoC may be categorized by etiology including structural, functional, infectious, inflammatory, and pharmacologic, the understanding of which drives diagnostic investigation, monitoring, acute therapy, and subsequent specialist care decisions including team-based local care as well as intra- and inter-facility transfer.
Conclusions: Acute adult DoC may be initially comprehensively addressed by the general intensivist using an etiology-driven and team-based approach. Certain clinical conditions, procedural expertise needs, or resource limitations inform transfer decision-making within a complex care facility or to one with greater complexity. Emerging collaborative science helps improve our current knowledge of acute DoC to better align therapies with underpinning etiologies.
Competing Interests: Dr. Chang received funding from the American Board of Internal Medicine, American Board of Psychology and Neurology Neurocritical Care, and Society of Critical Care Medicine (SCCM) for work as Associate Editor of Critical Care Medicine (2021–2023) and a past-President of the Neurocritical Care Society; she disclosed that she is employed by Duke University; and she serves as a Council member and Treasurer for SCCM and is a member of the Board of Rehabilitation Hospital of the Pacific. Dr. Provencio’s institution received funding from SCCM Weil Research Grant; he received funding from Minnetronix; he disclosed that he is an SCCM Council Member and on the Scientific Advisory Board for the Neurocritical Care Society Curing Coma Campaign; and he is a member of the steering committee of the Curing Coma Campaign. Dr. Pascual received funding from multiple medicolegal firms for expert testimony; and he is the Secretary of the SCCM. Dr. Livesay received funding from Stroke Challenges/Lombardi Hill LLC; she disclosed that she is the President of Neurocritical Care Society. Dr. Kaplan received funding from SCCM as President (2020–2021). Dr. Olson is a co-chair of the Neurocritical Care Society’s Neurocritical Care Research Network Subcommittee. Dr. Heavner has disclosed that she does not have any potential conflicts of interest.
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