Title: Clinical Study of Coma in Children
Authors: Luke Ravi Chelliah, Karthick AR, Theranirajan E, Dr Gangadharan S
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.12
Abstract
Background: Coma is a state of unarousable psychogenic unresponsiveness, in which the subjects lie with eyes closed. It has been an enigma for clinicians for many years and searching for the cause and prognosis is always a huge task.
Objective: To study the etiology of coma, find out morbidity and mortality pattern and to determine the outcome of coma in children.
Method: 60 children in the age group of 2 months to 12 years for a period of one year from January 2016 to December 2016, admitted with non-traumatic coma in the Department of Paediatrics, Govt, Vellore Medical College, Vellore were included in the study. A detailed history was taken and thorough examination was done according to the proforma. Patients were evaluated daily till discharge as advised or death. Outcome was classified into good recovery, moderate disability, severe disability, persistent vegetative state and death.
Results: The incidence of non-traumatic coma was 1.18% among all paediatric admissions. The common cause of non-traumatic coma in the present study was due to Metabolic-Toxic lesions (81.66%) as compared to structural lesions (18.34%). Mortality due to structural causes was high (18.18%) when compared to metabolic-toxic lesions. Low GCS, abnormal pupillary reflex, absent corneal reflex and Doll’s eye movement had significant impact on prognosis. Children with coma duration more than 48 hours had 22.22% mortality (p value 0.02).
Conclusion: CNS infections are the commonest cause of non-traumatic coma and it is possible to predict mortality and morbidity due to non-traumatic coma with simple clinical signs.
Keywords: Non-traumatic coma, metabolic-toxic lesions, structural lesions.
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