Outcome Of Non-traumatic Coma Research Articles

Outcome of non-traumatic coma in adults: A 3-year review in a Cameroonian referral hospital

Outcome of non-traumatic coma in adults: A 3-year review in a Cameroonian referral hospital

Aetiology and outcome of non-traumatic coma in African children: protocol for a systematic review and meta-analysis

BackgroundNon-traumatic coma is a common acute childhood presentation to healthcare facilities in Africa and is associated with high morbidity and mortality. Historically, the majority of cases were attributed to cerebral malaria (CM). With the recent drastic reduction in malaria incidence, non-malarial coma is becoming a larger proportion of cases and determining the aetiology is diagnostically challenging, particularly in resource-limited settings. The purpose of this study will be to evaluate the aetiology and prognosis of non-traumatic coma in African children.MethodsWith no date restrictions, systematic searches of MEDLINE, Embase, and Scopus will identify prospective and retrospective studies (including randomised controlled trials, cluster randomised trials, cohort studies, cross-sectional, and case-control studies) recruiting children (1 month–16 years) with non-traumatic coma (defined by Blantyre Coma Score ≤ 2 or comparable alternative) from any African country. Disease-specific studies will be included if coma is associated and reported. The primary outcome is to determine the aetiology (infectious and non-infectious) of non-traumatic coma in African children, with pooled prevalence estimates of causes (e.g., malaria). Secondary outcomes are to determine overall estimates of morbidity and mortality of all-cause non-traumatic coma and disease-specific states of non-traumatic coma, where available. Random effects meta-analysis will summarise aetiology data and in-hospital and post-discharge mortality. Heterogeneity will be quantified with τ2, I2, and Cochran’s Q test.DiscussionThis systematic review will provide a summary of the best available evidence on the aetiology and outcome of non-traumatic coma in African children.Systematic review registrationPROSPERO CRD42020141937

Nontraumatic coma in the pediatric intensive care unit: etiology, clinical characteristics and outcome

Background/aimThe purpose of this study was to evaluate the etiology, clinical characteristics, and outcome of nontraumatic coma (NTC) among children admitted to a pediatric intensive care unit (PICU). Materials and methodsA total of 159 children with NTC were included in the study. The modified Glasgow coma scale (GCS) was used to assess consciousness. Patients were classified with regard to etiology. For each patient, demographic and clinical characteristics, survival and degree of disability at PICU discharge were recorded. ResultsMedian age was 55 months (IQR: 17.0 - 109.0). The most common cause of NTC was neuroinfection (31.4%) followed by toxic-metabolic conditions (25.8%) and epileptic disorder (15.1%). There was no significant relationship between the level of encephalopathy at admission and NTC etiology. A total of 13 patients died (8.2%). Among the survivors, 61.6% were discharged without any neurologic deficit, 2.8% had severe neurologic disability, and 3.4% were in a vegetative state. Complete neurological recovery was significantly more common in patients with toxic metabolic disease, whereas neurological deficits were more frequent in patients with tuberculous meningo-encephalitis (P = 0.01 and P = 0.04, respectively). Higher pediatric risk of mortality III (PRISM III) score at PICU admission (Odds ratio: 1.51, 95% CI: 1.19 - 1.92; P < 0.001) was the only variable that was independently associated with mortality. The length of stay (LOS) at hospital (Odds ratio: 0.73, 95% CI: 0.58-0.91; P = 0.006) was associated with improved odds of survival.ConclusionsAlthough results obtained from this single-center study cannot be generalized to the pediatric population, the contribution to the literature in terms of the relationships between NTC etiology, and outcome can be crucial for clinical decision-making. We report neuroinfection as the most common cause of NTC, and the only factor that was closely associated with mortality was PRISM III score. Length of hospital stay was inversely correlated to patient mortality.

Value of coma scale in prediction of outcome in non-traumatic coma in 1-12 years old children

Value of coma scale in prediction of outcome in non-traumatic coma in 1-12 years old children

Clinical Profile, Etiology and Outcome of Non Traumatic Coma in a Tertiary Care Centre

Clinical Profile, Etiology and Outcome of Non Traumatic Coma in a Tertiary Care Centre

Study of clinical profile, etiology and immediate outcome in Non-traumatic coma in children

Study of clinical profile, etiology and immediate outcome in Non-traumatic coma in children

The etiology and outcome of non-traumatic coma in critical care: a systematic review.

BackgroundNon-traumatic coma (NTC) is a serious condition requiring swift medical or surgical decision making upon arrival at the emergency department. Knowledge of the most frequent etiologies of NTC and associated mortality might improve the management of these patients. Here, we present the results of a systematic literature search on the etiologies and prognosis of NTC.MethodsTwo reviewers independently performed a systematic literature search in the Pubmed, Embase and Cochrane databases with subsequent reference and citation checking. Inclusion criteria were retrospective or prospective observational studies on NTC, which reported on etiologies and prognostic information of patients admitted to the emergency department or intensive care unit.ResultsEventually, 14 studies with enough data on NTC, were selected for this systematic literature review. The most common causes of NTC were stroke (6-54%), post-anoxic coma (3-42%), poisoning (<1-39%) and metabolic causes (1-29%). NTC was also often caused by infections, especially in African studies affecting 10-51% of patients. The NTC mortality rate ranged from 25 to 87% and the mortality rate continued to increase long after the event had occurred. Also, 5-25% of patients remained moderately-severely disabled or in permanent vegetative state. The mortality was highest for stroke (60-95%) and post-anoxic coma (54-89%) and lowest for poisoning (0-39%) and epilepsy (0-10%).ConclusionNTC represents a challenge to the emergency and the critical care physicians with an important mortality and moderate-severe disability rate. Even though, included studies were very heterogeneous, the most common causes of NTC are stroke, post anoxic, poisoning and various metabolic etiologies. The best outcome is achieved for patients with poisoning and epilepsy, while the worst outcome was seen in patients with stroke and post-anoxic coma. Adequate knowledge of the most common causes of NTC and prioritizing the causes by mortality ensures a swift and adequate work-up in diagnosis of NTC and may improve outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-015-0041-9) contains supplementary material, which is available to authorized users.

Non traumatic coma in children: a prospective observational study

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.

From clinical judgment to odds: A history of prognostication in anoxic-ischemic coma

Persistent coma from a major anoxic-ischemic injury to the brain may indicate there is less chance for full recovery. The tools of prognostication to assess comatose survivors of cardiopulmonary resuscitation have developed over several decades. Physicians would initially base their judgment on experience and data on outcome in these patients in the early years were merely on awakening not on disability.In the late 1970s, a large multicenter prospective study was performed on outcome in nontraumatic coma. The impetus for this study was the result of Plum and Jennet's collaboration. In 1981 – for the first time – complex statistics were used to improve the accuracy of prognosis and became known as the “Levy algorithms.” These early seminal studies shaped the prediction models and implied that clinical information alone could assist physicians in making a prediction. Later, probabilistic methods became more commonplace.

Non-traumatic childhood coma in Ebonyi State University Teaching Hospital, Abakaliki, South Eastern Nigeria

Coma is a medical emergency, and optimal management, especially in a resource-poor setting, would depend on the knowledge of its etiology and predictors of outcome. This communication reviews the etiology and outcome of non-traumatic childhood coma in Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki. To determine the incidence, etiology and outcome of non-traumatic coma in children seen at the EBSUTH, Abakaliki. This is a retrospective analysis of records of all children admitted to the children emergency ward of EBSUTH in coma of a non-traumatic origin between 1 st of January and 31 st of December, 2007. Forty children presented with coma out of 673 children admitted during the study period, giving an incidence rate of 5.9%. The majority of the children (62.5%) were aged between 1 and 5 years of age, and 79.5% of them were deeply comatose on admission. Most of the cases (85%) of non-traumatic coma were due to infective causes, mainly cerebral malaria (47.5%), pyogenic meningitis (17.5%) and septicemia (10%). Twenty-four (60%) children recovered while 13 (32.5%) died. Infections were the predominant causes of non-traumatic coma in EBSUTH. In view of the high mortality among this group of patients, efforts at the control of malaria and other infections would significantly reduce the incidence of non-traumatic coma in this study site.

Predictive value of electroencephalography and computed tomography in childhood non-traumatic coma

To study value of electroencephalogram (EEG) and computed tomography (CT Scan) in predicting outcome of non-traumatic coma in children. 100 consecutive children, between 2 months to 12 years, with non-traumatic coma, (Glasgow Coma Scale score < 8). Demographic and clinical data was recorded at admission. EEG and CT scan were done within 24 hours of admission. Etiologic diagnosis was assigned on basis of clinical data and relevant laboratory investigations. The outcome was recorded as survived and died. Among survivors it was graded as no disability, or mild, moderate, or severe disability. Odds ratio and/or relative risk (RR) with 95% confidence interval (C I) were calculated. EEG could be done in 60 patients (43 survived; 7 were normal, 8 had mild, 17 moderate and 11 severe disability) CT scan in 93 patients (60 survived; 11 were normal, 14 had mild, 21 moderate and 14 severe disability). A normal/borderline EEG was associated with good outcome (P = 0.001); 11 of 12 survived and of survivors 55% had no or mild disability. Electrocerebral silence on EEG was a predictor of death (OR = 44 -sub .95% Cl - 1.5-7372; P = 0.01). An abnormal EEG was associated with significant increase in risk of disability among survivors (RR = 2.6, 95% Cl = 1.2-5.4, P = 0.03). Among CT abnormalities intracranial bleed suggested increased risk of death (RR = 2.1; 95% Cl - 0.8-5.3; P = 0.058), while, hydrocephalus was associated with better survival (RR = 0.7; 95% CI - 0.5 to 0.96; P = 0.029). However, hydrocephalus when compared with other abnormal CT scan findings, was associated with higher risk of moderate and severe disability among survivors (P = 0.046) A normal CT scan and EEG, and some of the specific findings could be helpful in predicting outcome in children with non-traumatic coma. EEG and CT scan should be done at admission in all patients with non-traumatic coma if feasible.

Incidence, aetiology, and outcome of non-traumatic coma: a population based study

AIMTo determine the incidence, presentation, aetiology, and outcome of non-traumatic coma in children aged between 1 month and 16 years.METHODSIn this prospective, population based, epidemiological study in the former Northern...

Prediction of outcome in non-traumatic coma in childhood.

The data in 104 comatose children were analysed, neonates and those with head injury being excluded. The median age was 30 months, with a range of one month to 17 years. 50% were normal, 32% died and the remainder had handicaps ranging from mild to severe. A number of individual clinical variables related with outcome. Stepwise multivariate discriminate analysis individually classified 75% of 102 cases correctly into one of 5 outcome groups, using clinical information obtained at the time of initial assessment within 12 hours of the onset of coma; 67% of 66 cases could be classified correctly on the basis of information available at 24 hours after the onset of coma. There were, respectively, 8% and 3% serious misclassification errors for the 2 time periods. Our data suggest that the stepwise procedure may be a useful method for the early prediction of outcome in comatose children. Classification errors may be minimized by enlarging the data base, by using alternate statistical methods and by taking into account information from investigative variables, the most promising of which seems to be multimodality evoked potentials.

Outcome of Non-traumatic Coma

Outcome of Non-traumatic Coma