Predictive value of electroencephalography and computed tomography in childhood non-traumatic coma
Pratibha D Singhi1, Arun Bansal, S Ramesh
1Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research Center, Chandigarh, India. drsinghi@glide.net.in
Insights
Electroencephalogram (EEG) and CT scans help predict outcomes for children with non-traumatic coma. Normal results indicate better survival and less disability, while specific abnormalities predict higher risks.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Critical Care Medicine
Background:
- Non-traumatic coma in children presents diagnostic and prognostic challenges.
- Electroencephalogram (EEG) and computed tomography (CT) scans are neurodiagnostic tools.
- Predicting outcomes is crucial for guiding treatment and managing patient care.
Purpose of the Study:
- To evaluate the predictive value of EEG and CT scans for outcomes in pediatric non-traumatic coma.
- To assess the association between specific EEG and CT findings and patient survival and disability.
- To determine the utility of early neuroimaging in managing non-traumatic coma.
Main Methods:
- A cohort of 100 children (2 months to 12 years) with non-traumatic coma (Glasgow Coma Scale score < 8) were studied.
- Demographic, clinical data, EEG, and CT scans were recorded within 24 hours of admission.
- Outcomes (survival, disability) were assessed, and statistical analyses (Odds Ratio, Relative Risk) were performed.
Main Results:
- Normal or borderline EEG correlated with good outcomes (P=0.001), with 55% of survivors having no or mild disability.
- Electrocerebral silence on EEG predicted death (OR=44, P=0.01), and abnormal EEG increased disability risk (RR=2.6, P=0.03).
- CT findings: intracranial bleed suggested increased death risk (RR=2.1, P=0.058), while hydrocephalus was linked to better survival (RR=0.7, P=0.029) but higher disability risk.
Conclusions:
- Normal CT scans and EEGs, along with specific findings, are valuable predictors of outcome in pediatric non-traumatic coma.
- EEG and CT scans should be considered for early assessment in non-traumatic coma patients when feasible.
- These neuroimaging modalities aid in prognostication and clinical decision-making for affected children.
Objectives:
To study value of electroencephalogram (EEG) and computed tomography (CT Scan) in predicting outcome of non-traumatic coma in children.
Methods:
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.
Results:
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)
Conclusion:
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.
