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

Article type: Research Article

Authors: Gowda, Vykuntaraju K.N. | Bannigidad, Ningappa B. | Kumar, Pragalath | Srikanteswara, Praveen-Kumar | Shivananda, | Govindraj, | Vykuntaraju, Sarala H. | Ramaswamy, Premalatha

Affiliations: Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, India | Department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, India | Department of Neurology, Bangalore Medical College and Research Institute, Bangalore, India | Department of Anatomy, Kempegowda Institute of Medical Sciences, Bangalore, India

Note: [] Correspondence: Dr. Vykuntaraju K.N. Gowda, Bangalore Child Neurology and Rehabilitation Center, HANS complex, 8/A 1st Main 1st Cross, Manuvana, Near Adhichunchanagiri Choultry, Vijayanagar, Bangalore, 560040, India. Tel.: +91 80 23301212, +91 9535212556; Fax: +91 80 26541799; E-mail: drknvraju@hotmail.com

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.

Keywords: Coma, childhood, Glasgow coma scale, intracranial infections, non-traumatic coma

DOI: 10.3233/JPN-140636

Journal: Journal of Pediatric Neurology, vol. 12, no. 1, pp. 35-43, 2014