Etiology and outcome of medical coma in a tertiary hospital in Northwestern Nigeria

Abstract

Background: Medical coma is a common cause of admission in emergency unit, medical wards and intensive care unit. A better understanding of causes and outcome, especially in a resource poor setting, is key to planning and improving rational approach to the management of medical coma. The study was undertaken to evaluate common etiologies and outcome of non- traumatic coma among adult patients in a tertiary hospital in Kano, Northwestern Nigeria. Materials and Methods: In this prospective observational study, adults patients in coma admitted to medical emergency unit of the Aminu Kano Teaching Hospital (AKTH), over a period of 19 months, were consecutively recruited. Etiology of coma was determined on the basis of history, clinical examination, relevant laboratory and radiological investigations. Outcome, over one month was recorded. Functional outcome of the survivors was assessed with Glasgow Outcome Scale. Results: A total of 194 (140 males, 54 females) patients constituting 8.1% of all medical emergencies seen during the study period were recruited. GCS at presentation was 8 in eight (4.1%) patients, 7 in thirty (15.5%) patients, 6 in fifty eight (29.9%) patients, 5 in forty (20.6%) patients, 4 in 34 (17.5%) patients, and 3 in twenty four (12.4%) patients. Etiologies identified were infections (28.9%), toxic and metabolic causes (28.9%), and stroke (23.7%). Mortality was 49%. When compared with infective causes of coma as a whole, more deaths were recorded from strokes than infections (28/46 and 24/56 respectively), however, the difference was not statistically significant (p = 0.070) with OR of 1.4, 95% CI (0.97-2.08). There was a statistically significant difference (p = 0.023) between patients with admission GCS of 3-5 and 6-8. Conclusion: Stroke, sepsis, diabetic emergencies and chronic kidney diseases were the most common etiologies of medical coma. Outcome of medical coma was comparable to what obtains in other places in the developing countries.