Etiology and Outcome of Non-traumatic Coma in Children Admitted to Pediatric Intensive Care Unit

Objective: Non-traumatic coma is a relatively common condition in children that may cause considerable mortality and morbidity. The purpose of this study was to determine clinical presentation, etiology and outcome of non-traumatic coma in children.
Methods: In a retrospective cross sectional study over a period of 5 years, files of 150 children aged between 1 month and 14 years admitted with non-traumatic coma to pediatric intensive care unit of Rasool Akram hospital were reviewed. Historical, presenting symptoms, clinical and laboratory data were collected. Etiology of coma was determined on the basis of clinical history and relevant investigations. The outcome was recorded as died or neurological condition at discharge as normal, mild or sever disability. Chi-square test was used to test the differences in categorical variables.
Findings: There were 63 (42%) boys and 87 (58%) girls. The mean±SD age of patients was 2.7±2.35 years. Systemic presentations including nausea, vomiting, fever, lethargy and poor feeding were more prominent in children under 2 years. Etiology of coma in 49 patients (32.7%) was infectious (meningitis, encephalitis, respiratory and systemic). Other causes were status epilepticus 44 (29.4%), metabolic (diabetic ketoacidosis, inborn errors of metabolism) 11 (7.3%), intoxications 10 (6.7%), accidental (drowning, electrical shock, suffocation) 9 (6%), shunt dysfunction (secondary to congenital brain malformations) 7 (4.6%), others (acute disseminated encephalomyelitis, vasculitis, hypertensive encephalopathy) 11 (7.3%), unknown 9 (6%). Infection occurred significantly (P=0.002) in children under 2 years of age, whereas accidents and intoxications were more prominent (P=0.004) in those between 2 and 6 years. Overall 25 children (16.6%) died. Of those survived 16 became severely disabled. Accidents and infections had higher mortality compared to other groups (P<0.001 and P=0.02 respectively).
Conclusion: Our results showed that infection was the most common cause of non-traumatic coma in childhood. Accidents and infection had higher mortality than other causes.