Non-traumatic Coma in Children in South-East of Iran

Khajeh, Ali; Miri‐Aliabad, Ghasem; Fayyazi, Afshin

doi:10.17795/compreped-25049

Cited by 4 publications

(7 citation statements)

References 16 publications

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“…But regarding age groups in relation to etiology, neuroinfection was most common in the 1 month to 1 year age group. A study from Iran found infectious encephalopathy most commonly in children < 2 years; whereas toxic coma was significantly more frequent in the -6 year age group [20].…”

Section: Discussionmentioning

confidence: 99%

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Nontraumatic coma in the pediatric intensive care unit: etiology, clinical characteristics and outcome

2021

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Non-traumatic coma in the pediatric intensive care unit: etiology, clinical characteristics and outcome ABSTRACT Background/aim: The purpose of this study was to evaluate the etiology, clinical characteristics and outcome of non-traumatic coma (NTC) among children admitted to a Pediatric Intensive Care Unit (PICU). Materials and methods: A total of 159 children with NTC were included in the study. The Modified Glasgow Coma Scale (GCS) was used to assess consciousness. Patients were classified with regard to etiology. For each patient, demographic and clinical characteristics, survival and degree of disability at PICU discharge were recorded. Results: Median age was 55 months (IQR: 17.0-109.0). The most common cause of NTC was neuroinfection (31.4%) followed by toxic-metabolic conditions (25.8%) and epileptic disorder (15.1%). There was no significant relationship between the level of encephalopathy at admission and NTC etiology. A total of 13 patients died (8.2%). Among the survivors, 61.6% were discharged without any neurologic deficit, 2.8% had severe neurologic disability and 3.4% were in a vegetative state. Complete neurological recovery was significantly more common in patients with toxic metabolic disease, whereas neurological deficits were more frequent in patients with tuberculous meningo-encephalitis (P = 0.01 and P = 0.04, respectively). Higher Pediatric Risk of Mortality III (PRISM III) score at PICU admission (Odds ratio: 1.51, 95% CI: 1.19-1.92; P < 0.001) was the only variable that was independently associated with mortality. The LOS at hospital (Odds ratio: 0.73, 95% CI: 0.58-0.91; P = 0.006) were associated with improved odds of survival. 2 Conclusions: Although results obtained from this single-center study cannot be generalized to the pediatric population, the contribution to the literature in terms of the relationships between NTC etiology and outcome can be crucial for clinical decision-making. We report neuroinfection as the most common cause of NTC, and the only factor that was closely associated with mortality was PRISM III score. Length of hospital stay was inversely correlated to patient mortality.

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Section: Discussionmentioning

confidence: 99%

“…In our study, the second most common etiology of NTC was toxic-metabolic causes. A study from Iran that included 123 children reported the most common cause of NTC as toxic encephalopathy (followed by infectious encephalopathy) [20]. In a series from Nigeria, epileptic encephalopathy was reported as the second most common cause of NTC [24].…”

Section: Discussionmentioning

confidence: 99%

Nontraumatic coma in the pediatric intensive care unit: etiology, clinical characteristics and outcome

2021

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“…This also emphasizes the challenges considered in an association of status epilepticus with the outcome due to potential confounding factors such as the underlying etiology of status epilepticus and heterogeneity of studies in terms of study design, study populations, and outcome measures [23,27]. Nonetheless, it should be noted that there is a considerable geographic difference in prevalent etiologies of NTC across the world and being familiar with the common causes of NTC coma in the specific geographical region is considered to be important for physicians to implement accurate diagnostic and therapeutic measures [21].…”

Section: Discussionmentioning

confidence: 99%

“…Infective pathologies are considered to be the most common cause of NTC in children in developing countries, while toxic-metabolic causes and HIE show higher prevalence in Western countries [3-5, 19, 20]. In addition, infectious etiology was also reported to be associated with higher mortality rates compared to other NCT etiology groups [3,4,6,8,9,20,21]. Our findings are in line with the high prevalence of infectious etiology in pediatric NTC cases, whereas do not support the associated high risk of mortality given the mortality rate of 5.9% in our patients NTC due to infectious etiology.…”

Section: Discussionmentioning

confidence: 99%

Pediatrik non-travmatik koma prognozunu öngörmede klinik, elektroensefalografik ve nöroradyolojik parametrelerin rolü

Anık¹,

Tekgül²,

Yılmaz³

et al. 2020

Pamukkale Medical Journal

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To investigate the early outcome of non-traumatic coma (NTC) in pediatric critical care in relation to the prognostic role of clinical, electroencephalographic, and neuro-radiological factors. Materials and methods: A total of 77 children (means of age: 70.5±68.7 months, 55.8% were boys) with acute encephalopathy, and NTC were included in this retrospective cross-sectional study. Data on patient demographics (age, gender, etiology of NTC) and prognostic factors [Glasgow coma scores (GCS), pupillary light reflex (PLR), electroencephalography (EEG) and cranial magnetic resonance imaging (MRI) findings] and neurological outcome (intensive care unit period and first 3 months after discharge) were recorded in each patient. Results: Hypoxic-ischemic encephalopathy (35.1%) and central nervous system infection (22.1%) were the most common etiologies in this study. The favorable and unfavorable neurological outcome was noted in 57% and 43% of patients, respectively. Lack of PLR (OR 3.09, 95% CI: 2.17 to 4.40, p<0.001), GCS ≤5 (OR 7.85, 95% CI: 2.77 to 22.37, p<0.001), poor prognostic pattern in EEG (OR 13.76, 95% CI: 1.62 to 116.54, p=0.004) and presence of MRI lesions (OR 4.04, 95% CI: 1.15 to 14.19, p=0.029) were significant determinants of unfavorable neurological outcome. Conclusion: We conclude that combined use of clinical, EEG, and MRI findings might provide a more accurate estimation of neurological outcome in pediatric NTC.

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“…In addition, monitoring the patients at the risk for decompensation based on coma scores enables a more complete assessment of their state of consciousness and better management from the moment they are admitted to the intensive care unit. 9 10 11 12…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Full Outline of Unresponsiveness Score with the Glasgow Coma Scale as a Coma Assessment Scale in Pediatric Intensive Care

Mısırlıoğlu

Yıldızdaş

Ekinci

et al. 2021

Journal of Pediatric Neurology

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Rapid assessment of cerebral dysfunction is crucial for the management of patients in intensive care units. The Glasgow Coma Scale (GCS) evaluates eye, verbal, and motor responses, but is insufficient to effectively evaluate patients on mechanical ventilation, or who are unable to speak. The Full Outline of Unresponsiveness (FOUR) score includes additional information such as brainstem reflexes and respiratory status to provide a more complete clinical assessment. In this study, we aimed to compare the FOUR score with GCS in the assessment of patients with coma. This prospective study included patients between 1 month and under 18 years of age, who were hospitalized in the pediatric intensive care unit due to risk of coma or ongoing impairment of consciousness between May 2018 and June 2019. Information regarding FOUR scores, GCS values, patient demographics, duration of hospitalization, requirement for mechanical ventilation, and patient comorbidities were recorded and analyzed. Among the 80 patients included in the study, a statistically significant correlation was found between (low) GCS and FOUR scores during admission, and mortality and requirement for mechanical ventilation. Monitoring the level of consciousness is important in pediatric intensive care units and may be predictive of the course and disease outcome. Similar to the GCS, the FOUR score is a good indicator for predicting mortality and requirement for mechanical ventilation.

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Non-traumatic Coma in Children in South-East of Iran

Cited by 4 publications

References 16 publications

Nontraumatic coma in the pediatric intensive care unit: etiology, clinical characteristics and outcome

Nontraumatic coma in the pediatric intensive care unit: etiology, clinical characteristics and outcome

Pediatrik non-travmatik koma prognozunu öngörmede klinik, elektroensefalografik ve nöroradyolojik parametrelerin rolü

Comparison of the Full Outline of Unresponsiveness Score with the Glasgow Coma Scale as a Coma Assessment Scale in Pediatric Intensive Care

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