The essential neurological examination of the unconscious patient in the emergency room

Abstract

ObjectiveTo determine whether neurologists with long‐term experience in the emergency room are in general agreement about the essential components of the neurological examination (NE) used on unconscious patients in whom an obvious cause for coma is lacking.MethodsWe surveyed 31 board‐certified practicing neurologists who regularly examine unconscious patients in the emergency room and asked them to list the specific components of the NE that they would normally choose to apply in at least 80% of cases.ResultsTwenty‐seven neurologists rated 24 of 38 items as essential steps of the neurological examination of the unconscious patient, with a high level of agreement amongst survey participants.ConclusionsThere was a high degree of consensus amongst the neurologists surveyed about which steps are essential for the NE of the unconscious patient. These findings provide an important source of validation for teaching this particular NE to medical students, as well as nonneurologists working in an emergency setting.

The Neurological Exam of a Comatose Patient: An Essential Practical Guide

“…The causes of coma may be reversible when detected early. It therefore seems pertinent that once we confirmed an unobstructed airway, that the patient is breathing, and that there is normal circulatory function, a structured and focused examination must be undertaken ( 1 ). The examiner should determine where is the lesion responsible for coma, the nature and what is the urgent steps that are needed at the time to prevent further neurological damage.…”