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Non traumatic coma
Arun Bansal1, Sunit C Singhi, Pratibha D Singhi
1Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research Center, Chandigarh, India.
Insights
Central nervous system (CNS) infections are the leading cause of non-traumatic coma in children. Simple clinical signs at admission and 48 hours predict patient outcomes, guiding prognosis for pediatric non-traumatic coma.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Infectious Diseases
Background:
- Non-traumatic coma in children presents a significant diagnostic and prognostic challenge.
- Understanding the common etiologies and identifying predictive clinical signs are crucial for effective management.
Purpose of the Study:
- To investigate the causes and clinical characteristics of non-traumatic coma in pediatric patients.
- To identify clinical indicators that predict the outcome of non-traumatic coma in children.
Main Methods:
- A study of 100 children (2 months to 12 years) with non-traumatic coma.
- Clinical signs, including Glasgow Coma Scale (GCS), respiratory patterns, pupillary reflexes, and motor responses, were assessed at admission and 48 hours.
- Etiology was determined through clinical evaluation and investigations; outcomes were categorized as survival with varying degrees of disability or death. Statistical analyses included chi-square tests and logistic regression.
Main Results:
- Central nervous system (CNS) infections were the most frequent cause (60%), followed by toxic-metabolic conditions (19%).
- Survival rates were higher for CNS infections compared to toxic-metabolic causes or intracranial bleeds (P < 0.05).
- Predictors of mortality included young age (<3 years), poor pulse volume, abnormal respiratory patterns, absent pupillary and extraocular movements, and papilledema.
Conclusions:
- Central nervous system infections are the primary cause of non-traumatic coma in children.
- Basic clinical signs assessed on admission and after 48 hours serve as reliable predictors of outcome in pediatric non-traumatic coma.
Objective:
To study the etiology and clinical profile of non-traumatic coma in children and to determine the clinical signs predictive of outcome.
Methods:
100 consecutive cases of non-traumatic coma between 2 months to 12 years. Clinical signs studied were temperature, pulse, heart rate, blood pressure, coma severity by Glasgow coma scale (GCS), respiratory pattern, pupillary and corneal reflex, extra ocular movements, motor patterns, seizure types and fundus picture. These were recoded at admission and after 48 hours of hospital stay. Etiology of coma was determined on basis of clinical history, examination and relevant laboratory investigations by the treating physician. The outcome was recorded as survived or died, and among those who survived as normal, mild, moderate, or severe disability. Chi-square test and logistic regression analysis were done to determine predictors of outcome.
Results:
Etiology of coma in 60% cases was CNS infection (tubercular meningitis-19, encephalitis-18, bacterial meningitis-16, others-7); other causes were toxic-metabolic conditions (19%), status epilepticus (10%), intracranial bleed (7%), and miscellaneous (4%). 65 children survived, 11 were normal, 14 had mild disability, 21 had moderate disability and 14 were severely disabled and dependent. Survival was significantly better in patients with CNS infection (63%) as compared to those with toxic-metabolic causes (27%) and intracranial bleed (43%, P < 0.05). On bivariate analysis age < or = 3 years, poor pulse volume, abnormal respiratory pattern and apnoea, abnormal pupillary size and reaction, abnormal extra ocular movements, absent corneal reflex, abnormal motor muscle tone at admission or 48 hours correlated significantly with mortality. Survival was better with increasing GCS (Spearman rho = .32, P < 0.001). On logistic regression age < 3 years, poor pulse volume, absent extraocular movements and papilloedema at admission and 48 hours after admission were independent significant predictors of death.
Conclusion:
CNS infections were the most common cause of non-traumatic coma in childhood. Simple clinical signs were good predictors of outcome.
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