Clinical profile and the outcome of children admitted to a tertiary care hospital with non-traumatic coma

Abstract

Objective: To study the clinical profile, the outcome and to determine clinical signs predictive of the outcome in pediatric patients admitted with non-traumatic coma. Methods: This prospective study was conducted over a period of two years on 150 children between age group 2 months and 14 years admitted with non-traumatic coma to the PICU of a tertiary care state government run hospital of eastern India. Clinical parameters at admission and at 48 hours were analysed. Relevant laboratory investigations and radiological studies were documented. Outcomes were analysed at the time of discharge or death. Results: CNS infection was the leading cause of coma in 57.3 % of the cases, out of which acute bacterial meningitis in 38.4% cases, encephalitis in 33.7% cases, cerebral malaria in 18.6% cases and tuberculous meningitis in 9.3% cases. The toxic-metabolic conditions (21.3%) were overall second followed by status epilepticus (7.4%), intracranial haemorrhage (4%), and others (10%). Among the 99 (66%) children survived, 59(39.3%) were normal, 17(11.3%) had mild, 17(11.3%) had moderate and 6(4%) had severe disability. Survival was highest in ischemic stroke patients (100%) followed by patients with CNS infection (71%). Poor pulse volume, abnormal blood pressure, respiratory pattern, poor GCS and abnormal brain stem reflexes at admission or at 48 hours showed significant correlation with mortality. The abnormal heart rate, abnormal motor pattern, the presence of papilledema and convulsion if present at 48 hrs were poor predictors of survival. Conclusion: CNS infection was the commonest aetiology and clinical signs at 48 hrs of admission were important predictors of mortality.