Abstract

CLINICAL PROFILE OF NONTRAUMATIC COMA IN CHILDREN

Author(s): Pankaj Vijaykumar Barabde1, Pratibha Vinay Kale2

BACKGROUND:  There is an increasing awareness that non traumatic coma is an important source of morbidity and mortality in the paediatric age group. These children make heavy demands on paediatric intensive care unit and neurorehabilitation resources. Coma is recognized to be a nonspecific sign with a wide potential differential diagnosis. METHODS This study was carried out over a period of two years in a tertiary care center. First 100 children between 1 month to 12 years old were included. A detailed clinical history was taken in each case. All patients were examined thoroughly, and all possible investigations like haematological, biological, microbiological, CSF, radiological, CT scan, and EEG were performed as and when required. Modified Glasgow coma scale was applied. RESULTS In the present study, 100 cases of nontraumatic coma with MGCS score less than 12 for more than 6 hours were studied. More than 50% cases i.e. 54 cases (54%) where of CNS infections while 13 cases (13%) of epilepsy, 18 cases (18%) of metabolic disorders, 7 cases (7%) of hypoxic ischemic encephalopathy and 8 cases (8%) of intoxication were observed. Age wise distribution of nontraumatic coma infants (27%), toddlers (16%), pre-schoolers (29%) and school going (28%) was noted. 44.44% mortality is observed in CNS infections. CONCLUSIONS In this study, maximum number of cases of CNS infections were seen in infants. However, epilepsy, metabolic disorders and hypoxia-ischemic encephalopathy were seen in school going, pre-schoolers and infants respectively. In intoxication maximum number of cases were equally distributed in pre-schoolers and school going children. However, CNS infections was the predominant cause of nontraumatic coma in all the groups. Mortality is highest in CNS infections and in infantile age group.