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Non-traumatic coma in paediatric patients: etiology and predictors of outcome
Saba Ahmed1, Kiran Ejaz, Muhammad Shahzad Shamim
1Department of Paediatrics, Dow University of Health Sciences.
Insights
Infections are the primary cause of non-traumatic coma in children and a leading cause of death. Key indicators of mortality include hypothermia, hypotension, and low Glasgow Coma Scale (GCS) scores.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Infectious Diseases
Background:
- Non-traumatic coma in children presents a significant clinical challenge.
- Identifying etiological factors and predictors of outcomes is crucial for effective management.
Purpose of the Study:
- To ascertain common causes of non-traumatic coma in pediatric patients.
- To evaluate potential predictors of morbidity and mortality in this population.
Main Methods:
- A cross-sectional study involving 100 children (up to 14 years) with non-traumatic coma.
- Data collected included demographics, clinical signs, laboratory results, and radiological findings.
- Statistical analysis used SPSS v.16, including chi-squared and Fisher's exact tests (P<0.05 significance).
Main Results:
- Infections were identified as the leading cause of mortality (79%).
- Significant predictors of mortality included hypothermia, hypotension, altered breathing, non-reactive pupils, low Glasgow Coma Scale (GCS), hypotonia, hyporeflexia, and low muscle power score.
- Among survivors, 58% had no disability, while 41% experienced some form of disability.
Conclusions:
- Infectious etiologies are predominant in pediatric non-traumatic coma and are strongly linked to mortality.
- Clinical signs such as hypothermia, hypotension, altered breathing, non-reactive pupils, low GCS, hypotonia, hyporeflexia, and reduced muscle power are significant indicators of poor prognosis.
Objective:
To determine the common etiological features of non-traumatic coma in children and evaluate possible predictors of morbidity and mortality in these patients.
Method:
A cross sectional study was carried out at the Paediatric Department of Civil Hospital Karachi from February 2008 to February 2009. In total 100 children, up to 14 years of age having history of non-traumatic coma were included. At the time of enrolment demographic data, clinical features, laboratory parameters and radiological workup were recorded. Data was entered and analyzed with SPSS version 16. Descriptive statistics were generated for all variables. Relationships between categorical variables were evaluated by examining cross-tabulations, chi2 test and Fisher's exact tests. P-values < 0.05 were considered statistically significant.
Results:
Mean age of the patients in months were 45 months. Male female ratio was 1.45:1. Among 65 survivors 38 (58%) showed no disability and 27 (41%) showed disability. Infections emerged as major cause of mortality (n=23, 79%). Clinical features that showed association with mortality included hypothermia (P = 0.032), hypotension (P = 0.002), altered breathing pattern (P = 0.0001), non reactive pupils (P = 0.001), low Glasgow coma scale (GCS) (P = 0.038), hypotonia (P = 0.002), hyporeflexia (P = 0.0001) and muscle power score of two (P = 0.043).
Conclusion:
Infections were the leading cause of non-traumatic coma as well as the leading cause of mortality in our study. Hypothermia, hypotension, altered breathing pattern, non reactive pupils, low GCS, hypotonia, hyporeflexia and low muscle power score were significantly associated with mortality in children presenting with non-traumatic coma.
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