Author(s): Mallikarjun R. Patil1, Vinod Muniyappa2, Prasanna D. H3
Acute non-traumatic coma is one of the most common paediatric emergencies, which arouses much anxiety and apprehension in both parents and physicians. Due to heterogeneity of causes in these patients, prediction of outcome is difficult and unfortunately no single clinical, laboratory or electrophysiological parameters singly predict their outcome. Aetiology of non-traumatic coma varies depending on different geographical area. We have attempted to find the incidence, aetiology and outcome and delineate neurological signs to predict the prognosis in this study.
The aim of this study is to study the incidence, aetiology and outcome of non-traumatic coma in children.
MATERIALS AND METHODS
100 consecutive cases of non-traumatic coma between 5months and 15 years of age were selected for the study. Clinical signs and findings were recorded at admission (‘0’ Hr) and after ‘48’ Hrs. of hospital stay. Aetiology of coma is determined on the basis of clinical history, examination and relevant laboratory investigations by the treating physician. These children were followed up till the death in the hospital or discharged from the hospital. Discharged patients were asked for followup after 4 weeks. During this period, all of them were evaluated by formal neurological examination and for special sensory involvement. The neurological outcomes were categorised into 6 groups (I-VI) based on the severity of neurological involvement. Chi-square test was applied to determine the predictors of outcome.
1. The incidence of non-traumatic coma in our hospital based study was 8.02% of all paediatric admissions and 21.64% of all PICU admissions.
2. CNS infections contributed the majority (58%) of cases. (Dengue encephalitis-28%, viral encephalitis-12%, TB meningitis-8%, pyogenic meningitis- 6%, Shigella encephalopathy-3% and cerebral malaria-1%).
3. Other non-infectious aetiologies were toxic and metabolic group- 21%, post status epilepticus- 9%, intracranial bleed-5% and others contributed-7% of cases. Survival was significantly better in CNS infections group (77.6%) as compared to those with toxic and metabolic causes (57.1%) and intracranial bleed (40%).
4. Low MGCS Score (3-5) was associated with high mortality and survival was better with increasing MGCS score (p<0.001).
Neuroinfections contribute majority of cases of non-traumatic coma in children followed by toxic metabolic group. The overall outcome of CNS infections was significantly better than toxic/metabolic group and among survivors most of them improved with intact neurological outcome. Clinical variables and MGCS score remain the most readily available tools for assessment of non-traumatic coma and also help in prediction of outcome.