Etiology, Clinical Profile and Outcome of Non-Traumatic in Children
Keywords:
Coma, Neurological, Mortality, Traumatic injury, PediatricAbstract
Abstract: Background: Non-traumatic coma in children is a neurological emergency associated with high risk of mortality and undesired consequences.
Objective: To investigate the etiology, clinical profile and neurological and clinical outcome in children presented with non-traumatic coma at National Institute of Child Health Karachi.
Materials and Methods: A prospective follow-up study was conducted on inpatients visiting pediatric department of National Institute of Child Health Karachi. The study period was six months from 20th December 2022 to 19th June 2023. One hundred and forty-three non-traumatic coma children of age 2 months to 16 years were consecutively selected for investigation. Each child was assessed for vitals, GCS score, duration of unconsciousness and presenting complaints. Laboratory investigations were performed to confirm the etiology of non-traumatic coma. Each child was followed until hospital discharge for final neurologic and clinical outcomes.
Result: Out of 143 non-traumatic coma children, male children were 77 (53.8%) and female children were 66 (46.2%) with mean age of 6.74 ± 2.68 years. The most common clinical presentation was fever 123 (86.0%) followed by convulsions 117 (81.8%), headache 112 (78.3%), fast breathing 83 (58.0%), vomiting 70 (49.0%) and abdominal pain 52 (36.4%). Viral encephalitis 41 (28.7%) and acute bacterial meningitis 31 (21.7%) were the most common infectious; while epilepsy 24 (16.8%) and acute poisoning 11 (7.7%) were the most common non-infectious etiologies of nontraumatic coma. The most common neurological outcome was moderate disability 80 (55.9%) children followed by mild and severe disability in 32 (22.4%) and 31 (21.7%) children, respectively. Overall, 112 (78.3%) non-traumatic coma children survived while 31 (21.7%) children died.
Conclusion: Infections were the most common cause of non-traumatic coma and also the most common cause of death in children. Meningitis including acute bacterial meningitis and tuberculosis meningitis was the only significant cause of death in children of non-traumatic coma. Death was significantly associated with severe disability.
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