The focus of the Curing Coma Campaign ACute cOma PragMatic Prospective ObSErvational (COMPOSE) Study is to: 1) accurately define the natural history of coma recovery in the acute phase of neurological injury, 2) establish a prototype hub-spoke based research network with central governance utilizing database infrastructure under the Curing Coma Campaign, and 3) explore the variability in care influencing patient outcomes. We propose a prospective, pragmatic, multicenter study to recruit 425 patients with acute coma to detail the natural history of coma recovery. Our study is the first step towards addressing several of the critical research gaps identified by the Curing Coma Campaign. Ours will be the first study to evaluate recovery in coma from a variety of etiologies, in a global diverse population utilizing standardized, pragmatic outcome measures. We plan to incorporate comorbidities as well as secondary hospital complications that can influence patient outcomes, thereby providing a real-world roadmap of phenotypic coma recovery under each etiology. Our work hereby creates a platform upon which future studies can develop a biomarker overlay to define coma endotypes.