Toxic coma characteristics and predictors of outcome in cases admitted to Menoufia poisoning and addiction control center [MPCC]

Although the incidence of poisoning is difficult to estimate accurately, the wide availability and accessibility of chemicals and their extensive use in a variety of applications including medicine, agriculture and industry, has increased the risk of poisoning. Severely ill patients from different toxic substances may need intensive care unit [ICU] admission for different causes including coma. Reed Coma Scale was found to be appropriate for classification and prediction of severely poisoned cases. The present work aimed at describing the demographic and clinical characteristics in toxic coma cases, and to identify and evaluate predictors of outcome. All toxic coma cases admitted to MPCC through a period from 1-1-2009 to 30-6-2009 were evaluated. The toxic coma cases were further studied by statistical tests [X2, and multivariate linear regression analysis]. Out of 769 poisoned cases, 60 cases [7.8%] were found comatose. Males surpassed females. Toxic coma cases were prevalent in the age group 18 -50 years [43.3%] followed by age group < 7 years [26.7%]. Rural cases performed 90% while urban cases were 10%. Single cases represented 66.7%. Correlating mode of poisoning to age and sex showed significant prevalence of suicidal in females and accidental mode in males. Grades of coma using Reed's classification correlated to type of poisoning showed prevalence of GIV in snake and insecticide poisoning and G I, II and III in food poisoning, drugs and insecticides respectively. Metabolic acidosis was significantly correlated to drug poisoning and agrochemicals [dormex], while hypoxia and respiratory acidosis were significantly associated with Co poisoning and snake bite. ECG changes showed tachycardia and atrial fibrillation in association to snake bites, drugs and insecticides. Meanwhile bradycardia was associated to dormex. Mortality rate was 20% of all toxic coma cases. Fifty percent of fatalities were in age group 18 - 50 years old while all toxic coma cases above 50 years had died. Studying predicting factors of outcome in toxic coma showed that age group 18 - 50 years was two times risky than 7-18 years. Snake bite, insecticides and dorm ex, grades III and IV coma were significant risk factors. Also accidental mode of exposure was found to be significant risk factor. Age group 18-50 years, snake bite, insecticides and dormex, coma grades I II and IV and accidental mode of poisoning were the most significant risk factors in the outcome of toxic coma. So study of characteristics of toxic coma cases together with identification of the most risk factors correlated to outcome, that will help in the prediction of outcome and elucidate the intensive measures that could be taken to improve the outcome as well as decrease the burden of the costs to the patient and the community

The Thai Anesthesia Incident Monitoring Study (Thai AIMS) of postoperative central neurological complications.

OBJECTIVE: To analyze the incidents of central neurological complication in the Thai Anesthesia Incident Monitoring Study (Thai AIMS). MATERIAL AND METHOD: A prospective descriptive multi-centered study of incident reports was conducted in 51 hospitals across Thailand from January to June 2007. Voluntary and anonymous reports of any adverse events during the first 24 hrs of anesthesia were sent to the Thai AIMS data management unit. Three anesthesiologists reviewed the possible central neurological complication reports. Descriptive statistics was used RESULTS: There were 16 relevant incident reports of central neurological complications (7 cases of convulsion, 5 cases of cerebro-vascular accident and 4 cases of coma). Majority of patients appeared to be old with underlying co-morbidities undergoing major surgical procedures under general anesthesia and required more intensive intra-operative monitoring. These complications occurred commonly with patients of orthopedics, cardiac, urologic and neurosurgical surgery. The majority of cerebro-vascular accident (80%) and coma (75%) were considered preventable. CONCLUSION: Inappropriate decision making and inexperienced anesthesiologists were common contributing factors while suggested corrective strategies were quality assurance activity, clinical practice guidelines and improvement of supervision.

Perioperative stroke and coma in Thai Anesthesia Incidents Study (THAI Study).

OBJECTIVES: To analyze perioperative stroke and coma using database of Thai Anesthesia Incidents Study (THAI Study) with regard to frequency, contributing factors, preventive and corrective strategies. MATERIAL AND METHOD: Details of perioperative neurological complications comprising stroke and coma in one year were recorded prospectively by attending anesthesiologists or nurse anesthetists in standardized record forms. All data were analyzed to identify contributing factors and preventive strategies. RESULTS: Among 172,592 anesthetics, there were 24 cases of coma, and 28 cases of stroke. Most cases of coma that eventually died (12/16 cases, 75%) had ASA physical status (ASA PS) ranging from 2E to 5E. Perioperative stroke was found mainly in patients with ASA PS 3 and most of the incidence (74%) occurred in patients who had no previous history of stroke. These patients already had pre-existing cardiovascular diseases and underwent high risk procedures. There were 54% of perioperative stroke cases that could be due to improper cardiovascular management and 42% due to improper emergency neurological management. CONCLUSION: The incidence of perioperative stroke and coma in this study was approximately 0.03%. The majority of cases had no prior stroke or coma, which suggested that a problem during perioperative period itself might predispose patients to these complications. Preventive strategies included quality assurance activity, improved communication, and practice guideline.

there any relationship of age and sex to the etiology and outcome of medical coma?

As the diseases behave differently in males and females and even in different age groups, particular attention was made to classify and observe the distribution of various causes of coma according to age and sex of the patient in order to formulate our indigenous database for future reference. We studied the coma etiology with particular reference to the age and sex of the patient, and the outcome. All the 517 [312 male [60.35%] and 205 female [39.65%]] patients were divided into 7 groups according to decades from age 12 to 80 years. Patients older than 40 years predominated [318 [61.5%]]. Metabolic coma was predominant cause in almost all age groups. Structural coma was increasing progressively with the age. Poisonings were the common cause in patients under 30, representing 35.85% of all comas in the age group 12-20, and 33.70% in the group from 21-30 years. In the next two decades [31-50 years], hepatic and renal failure predominated making up more than half of all causes. Leading causes among males we re poisonings [69 cases], hemorrhagic CVA [48 cases], ischemic CVA [24 cases], renal failure [28 cases] and hepatic coma [35 cases]. Similarly among females causal distribution revealed renal failure [34 cases], followed by hepatic coma [29 cases], and hemorrhagic CVA [26 cases]. Out of the 476 [92%] patients whose outcome could be determined 297 [57.4%] were discharged after recovery and 179 [34.6%] died. Eighty out of 205 female patients died [39%], while 99 out of 312 males had a fatal outcome [31.7%]. We conclude that coma etiology has a significant effect on prognosis, while such significance could not be assigned to age or sex