Coma

Definition

The definition supported here is to create consistency on the clinical definition of “coma” and allow the appropriate capture of codes. However,  the use of descriptive language like “unresponsive” cannot be captured.

The importance of documenting “coma” also has an impact on quality ratings. Appropriately documenting coma will positively impact our perceived risk of mortality and the overall acuity of the patient.

Use of the Glasgow Coma Scale

Combined scores of 8 or lower, in either the Pediatric or Adult Glasgow Coma Scale (GCS),  are thought of as consistent with coma. GCS scores greater than 8 describe individuals who are obtunded, poorly responsive, and/or disoriented, but not necessarily in a coma. 

Glasgow Coma Scale is not validated in children <2 years of age; instead support coma diagnosis with clinical documentation.

Glasgow Coma Scale

Table 1: Modified Glasgow Scale for Infants
Score 1 2 3 4 5 6
Eye Does not open eyes Opens eyes in response to painful stimulation Opens eyes in response to speech Opens eyes spontaneously N/A N/A
Verbal No verbal response Inconsolable, agitated Inconsistently inconsolable, moaning Cries but consolable, inappropriate interactions Smiles, orients to sounds, follows objects N/A
Motor No motor response Extension to pain Abnormal flexion to pain for an infant Withdraws from touch Withdraws from touch Moves spontaneously or purposefully
Table 2: Modified Glasgow Scale for Adults
Score 1 2 3 4 5 6
Eye Does not open eyes Opens eyes in response to painful stimulation Opens eyes in response to voice Opens eyes spontaneously N/A N/A
Verbal Makes no sound Inconsolable sounds Utters inappropriate words Confused, disoriented Oriented, converses normally N/A
Motor Makes no movement Extension to painful stimuli Abnormal flexion to painful stimuli Flexion/Withdrawal to painful stimuli Localized painful stimuli Obeys commands
Table 3: Diabetes with Coma
Diagnosis DKA, Type 1 with Coma Hypoglycemic coma with Type 1 Hypoglycemic coma with Type 2 Non-diabetic Hypoglycemic Coma Hyperglycemic Hyperosmolar state with Coma
ICD-10 E10.11 E10.641 E11.641 E15 E11.01
Glucose >250 <60 <60 <60 >600
pH (venous) <7.3 >7.25
HCO3- (meg/L) <15 >15
GCS Score

Document patient’s clinical status (i.e. patient is in a comatose state):

  1. Document the Glasgow Coma Scale score, including timing of assessment

  2. Provide an underlying cause (i.e. medication induced with TBI protocol)

  3. Document duration of the coma and if patient returned to pre-existing level of consciousness

  4. Physical exam should reflect mental status

Tips for Documenting Coma