Nontraumatic Coma in a Tertiary Pediatric Emergency Department in Egypt: Etiology and Outcome

Abstract

Nontraumatic coma in childhood is an important pediatric emergency with a wide range of primary etiologies. This prospective descriptive study of 100 consecutive pediatric nontraumatic coma cases was done to identify etiology, clinical profile, and predictive outcome in a pediatric emergency department at a tertiary care university hospital. Most frequent etiologies were metabolic (33%), central nervous system infections (28%), and intracranial hemorrhage (13%). In the emergency department, 50% of those patients died. Hypothermia, hypotension, flaccidity, and poor Glasgow coma scale at admission correlated significantly with mortality. After 48 hours of admission, poor pulse volume, poor Glasgow coma scale, abnormal respiratory pattern/apnea, and seizures correlated significantly with mortality. On logistic regression, poor Glasgow coma scale at admission, abnormal respiratory pattern, and seizures after 48 hours of admission were independent significant predictors of mortality. Metabolic causes are the most common etiology in pediatrics nontraumatic coma. Simple clinical signs were good predictors of outcome.