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

Abstract

Non-traumatic coma in the pediatric intensive care unit: etiology, clinical characteristics and outcome ABSTRACT Background/aim: The purpose of this study was to evaluate the etiology, clinical characteristics and outcome of non-traumatic coma (NTC) among children admitted to a Pediatric Intensive Care Unit (PICU). Materials and methods: A 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. Results: Median 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 LOS at hospital (Odds ratio: 0.73, 95% CI: 0.58-0.91; P = 0.006) were associated with improved odds of survival. 2 Conclusions: Although 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.

Non-traumatic coma in young children in Benin: are viral and bacterial infections gaining ground on cerebral malaria?

“…The remaining three had no evidence of meningitis or BSI and had a favorable outcome. These findings contrast with those from other parts of the world where non-infectious (metabolic, vascular) etiologies of comas are more prevalent [ 15 , 16 ].…”

Clinico-Etiological Profile and Predictors of Mortality of Nontraumatic Coma in Children of Upper Egypt: A Prospective Observational Study

“…These etiologies are slightly different than those found in Turkey where hypoxic ischemic encephalopathy was as common as CNS infections. [19][20][21][22] In accordance with Gwer et al, 23 our study showed that viral encephalitis was the most common CNS infection. This differs from other studies that revealed a higher frequency of acute bacterial meningitis.…”

Transfusion Ratios and Deficits in Injured Children With Life-Threatening Bleeding*

“…leeding is an important cause of preventable death in children (1)(2)(3). Reported 28-day mortality rates in children with life-threatening bleeding range from 36% to 50% (4,5), substantially higher than the mortality rates for nonbleeding pediatric cohorts with comparable illness severity (8-16%) (6)(7)(8) and the mortality rates reported in injured adults with life-threatening bleeding (21-24%) (9,10). Hemostatic resuscitation has evolved over recent decades to include early blood product transfusion, avoidance of crystalloid, prevention of coagulopathy, hypothermia, hypocalcemia and acidosis, and surgical or interventional control of bleeding when applicable (11,12).…”