Predictors of non-traumatic coma in a pediatric cohort from a South Indian tertiary care center: Results of a multivariate analysis

Abstract

Objective: To study the etiology and clinical profile of non-traumatic coma in children at tertiary care center and to determine the predictors of outcome. Methods: One hundred and four consecutive children between 2 mo-12 yr were studied. The clinical signs at admission; vital signs, Glasgow coma scale, respiratory pattern, papillary reflex, extra-ocular movements, fundus picture and motor deficits were recorded. Etiology of coma was determined by clinical history, examination and relevant investigations. Their progress was monitored clinically, biochemically and with multi-system monitors. Outcome was recorded as survived or died. Results: Etiology of coma in 65% cases was intracranial infections; other causes were metabolic (20%). Sixty-seven percent recovered completely, 16% had residual neurodeficits, 16% died. Survival was better in children with intracranial infections (13%) as compared to metabolic coma (33%). On multivariate logistic regression, bradycardia, hypotension, abnormal respiratory pattern (especially, ataxic type), duration of coma more than 48 h, Glasgow coma scale < 7 at admission, unequal and non-reactive pupils, papilledema, abnormal extra-ocular movements, motor deficits, signs of meningitis correlated with mortality. Requirement of ventilatory support and abnormal computerized tomography findings correlated with mortality. Conclusions: Intracranial infections were the most common cause of non-traumatic coma in children; the most common cause of death being metabolic coma. Simple clinical signs and relevant investigations served as prognostic indicators of outcome.

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

“…The modified GCS scoring system was used [3]. The GCS of patients and its relationship with prognosis and etiology were assessed by dividing the study population into three groups depending on the level of consciousness at admission: the first group was comprised of those with a GCS score of 10-12 (mild encephalopathy), the second group had moderate encephalopathy (GCS: 7-9), and the third group had severe encephalopathy (GCS: [14,15,16].…”

“…[10,11,12]. There are only a few studies in which NTC has been evaluated in terms of severity, etiology and prognosis [13,14]. In this study, our aim was to determine the etiology and clinical characteristics of patients, and the factors that were associated with mortality and degree of disability in pediatric patients with NTC who were admitted to a tertiary-hospital PICU.…”