Etiology and Outcome of Non-Traumatic Coma in the Pediatric Emergency Department

Non-traumatic coma in childhood is an important pediatric emergency. It can result from a wide range of primary etiologies. Objective: To study the etiology and clinical profile of pediatric non-traumatic coma and to determine the clinical signs predictive of outcome. Setting: Pediatric emergency department (PED) at a tertiary care university teaching pediatric hospital from September 2007 to January 2008. Patients and Methods: A prospective descriptive study of 100 consecutive pediatric non-traumatic coma cases was done. Clinical signs studied were vital signs, coma severity by Glasgow coma scale (GCS), respiratory pattern, pupils, corneal reflex, motor patterns and seizures. These were recorded at admission and after 48 hours of hospital stay. The outcome was recorded as survived or died, and among those who survived as normal, mild, moderate, or severe disability. Results: The total number of patients with non traumatic neurological emergencies during the study period was 100 patients representing 14.4% of all pediatric emergency cases. The most frequent etiologies were metabolic causes (33%), CNS infections (28%) and intracranial hemorrhage (13%). Fifty percent of those patients died in the PED. On bivariate analysis, hypothermia, hypotension, flaccidity and poor Glasgow coma scale at admission correlated significantly with mortality. However, after 48 hours of admission, poor pulse volume, poor Glasgow coma scale, abnormal respiratory pattern/apnea and presence of seizures correlated significantly with mortality. On logistic regression, poor Glasgow coma scale at admission while abnormal respiratory pattern and seizures after 48 hours of admission were independent significant predictors of mortality. Conclusion: Metabolic causes are the most common cause of non-traumatic coma in pediatrics. Simple clinical signs were good predictors of outcome. Emergency room guidelines developed for non traumatic coma should target the most common presenting problem categories.