ABSTRACT
Background: Coma is a medical emergency; and optimal management; especially in a resource-poor setting; would depend on the knowledge of its etiology and predictors of outcome. This communication reviews the etiology and outcome of non-traumatic childhood coma in Ebonyi State University Teaching Hospital (EBSUTH); Abakaliki. Objective: To determine the incidence; etiology and outcome of non-traumatic coma in children seen at the EBSUTH; Abakaliki. Materials and Methods: This is a retrospective analysis of records of all children admitted to the children emergency ward of EBSUTH in coma of a non-traumatic origin between 1 st of January and 31 st of December; 2007. Results: Forty children presented with coma out of 673 children admitted during the study period; giving an incidence rate of 5.9. The majority of the children (62.5) were aged between 1 and 5 years of age; and 79.5of them were deeply comatose on admission. Most of the cases (85) of non-traumatic coma were due to infective causes; mainly cerebral malaria (47.5); pyogenic meningitis (17.5) and septicemia (10). Twenty-four (60) children recovered while 13 (32.5) died. Conclusion : Infections were the predominant causes of non-traumatic coma in EBSUTH. In view of the high mortality among this group of patients; efforts at the control of malaria and other infections would significantly reduce the incidence of non-traumatic coma in this study site
Subject(s)
Child , Coma/etiology , Hospitals , Incidence , TeachingABSTRACT
Justification: Le coma non traumatique traduit une alteration de la conscience survenant d'une facon spontanee; d'origine multifactorielle. C'est une urgence diagnostique et therapeutique. Le pronostic du patient comateux depend surtout de la precocite et de la qualite de la prise en charge initiale. Objectif : Cette etude essaie de determiner les facteurs de mauvais pronostic des comas non traumatiques chez 449 patients comateux; hospitalises dans le service de reanimation medicale du CHU Antananarivo/Hopital Joseph Raseta Befelatanana. Resultats : Les facteurs incrimines sont le sexe masculin; l'age avance; l'intersaison; les antecedents (alcoolisme; hypertension arterielle; accident vasculaire cerebral; broncho-pneumopathies chronique); la brutalite de l'installation du coma. D'autres parametres sont responsables des comas et aggravent le pronostic des patients : la deshydratation; l'hyperthermie superieure a 40oC; la pression arterielle tres elevee ou imprenable; la polypnee au-dela de 45cycles/min; la SpO2 basse; la tachycardie superieure a 140/min ou la bradycardie inferieure a 40/min. La decouverte de causes evidentes (hypoglycemie; pathologies vasculaires; coma ethylique complique; coma hepatique et infectieux) permet de cerner le diagnostic etiologique. Conclusion : La presence de ces facteurs de mauvais pronostic impose une prise en charge rapide et efficace afin de reduire le taux de morbi-mortalite