Non-traumatic Coma: Causes and Outcome of Adult Patients at University of Gondar Hospital, Northwest Ethiopia

Abstract

Coma represents a serious, life-threatening medical condition which should be treated effectively. It is important to recognize the underlying causes of coma in order to provide timely medical treatment. There is dearth of data on causes of medical coma in adults in Africa. This research aimed at determining the cause and outcome of coma in University of Gondar Hospital. Methods: A prospective observational descriptive study was conducted from 01/01/2014 to 31/06/2014 G.C in University of Gondar Hospital. All consecutive non trauma patients admitted to the medical wards with a Glasgow Coma Scale of 8 or less were included. An interview administered questionnaire to patient attendants and neurologic examination were employed to collect data like sociodemographics and clinical features. All important laboratory tests and outcome data were documented at patient discharge. Verbal consent from attendants was taken. Data was entered to and analyzed using Epiinfo7. Result: A total of 53 patients constituting approximately 3.4% of the medical emergencies seen during the study period were included in the study. The most common cause of coma were diseases that cause no focal neurologic deficit (FND), occurring in 31 (58.5%) patients. Among the causes with non-localizing signs, the most common causes were intoxications, uremic and hepatic encephalopathies, occurring in 11 (20.8%), 7 (13.2%), and 5 (9.4%) of the patients, respectively. Organophosphate (malathion) poisoning was the most common agent of intoxication responsible for 9 patients out of 11. These were followed by diseases with FND and meningitis syndromes, occurring in 14 (26.4%) and 8 (15.1%) patients, respectively. Among the patients admitted with coma without FND, 17 (54.8%) of the patients died, 6 (19.3%) had disability and 8 (25.8%) patients were discharged with improvement. In contrast, among patients admitted with coma with FND, no patient was discharged with improvement, 7 (50%) died and 7 (50%) were disabled. Among patients admitted with meningitis syndrome, 4 (50%) died, 2 (25%) were disabled and 2 (25%) were discharged with improvement. Conclusion: Diseases presenting without focal neurologic deficit, including toxic and metabolic causes, are the most common causes of coma. Among these, the most common was malathion poisoning which is reversible with appropriate care. Meningitis syndrome was not found to be a prominent cause of coma. Medical coma, regardless of the etiology, was associated with high mortality rate.