Non traumatic coma in children: a prospective observational study

Abstract

Background: Non Traumatic Coma (NTC) in children is an important pediatric emergency. It has been an enigma for clinicians for many years. To find the cause of coma and to determine the prognosis is a taxing question for the attending clinicians and the primary concern for relatives in every case. Objective: To study the etiology, clinical profile, and to determine the clinical signs predictive of outcome in non-traumatic coma in children aged between 6 months and 12 years. Methods: Sixty-one consecutive cases with details of demographic data, history and clinical examination at admission and after 48 hours were recorded in a predesigned proforma. The clinical variables recorded were heart rate, respiratory rate and pattern, blood pressure, temperature, coma severity (using modified Glasgow Coma Scale), pupillary size and response to light, extra ocular movements and fundus picture. Etiology was classified into infections, toxic-metabolic, hypoxic-ischemic, post-status epilepticus, intracranial bleeding and miscellaneous. The outcome was recorded as survived or died, and among those who survived as normal, mild, moderate, or severe disability. Results: Infection was the commonest cause of non-traumatic coma accounting for 25 (41%) cases. Toxic-metabolic 16 (26.2%), status-epilepticus in 10 (16.4%), 5 (8.2%) were caused by structural CNS lesions and in 5 (8.2%) cause could not be determined. In infectious causes, encephalitis was the largest subgroup contributing to 10 (16.4%) cases. Overall mortality was 33.9 % in our study. 40.9 % were normal or had mild disability and 23 % had moderate to severe disability when examined at discharge. The mortality was higher in cases of toxic-metabolic coma (43.8%) than in CNS infections (29.2%) or status-epileptics (10%). Factors that correlated significantly with mortality both at admission and after 48 hours were age ≤3, poor pulse volume, hypotension, abnormal respiratory pattern, abnormal pupils, absent corneal reflex, abnormal extra-ocular movements, lower modified GCS and papilledema. Conclusions: CNS infections are the commonest cause of non-traumatic coma; simple clinical signs are strong predictors of both morbidity and mortality.