Clinical characteristics and outcome of children with non-traumatic coma: Experience from a tertiary hospital in Rivers State, Nigeria.

Abstract

Background: Non-traumatic coma (NTC) is a common neurological emergency associated with high morbidity
and mortality. This study investigates the clinical features and outcomes in children at the University of Port
Harcourt Teaching Hospital (UPTH), Port Harcourt, Rivers State.
Methodology: A prospective study was conducted from 2021-2023 involving 406 patients who presented with
NTC in the children's emergency ward and were consecutively recruited into the study. Consent was obtained from
parents/caregivers. Data on age, sex, and clinical history were collected. The aetiology of NTC was determined
based on history, clinical examination, and laboratory investigations. The degree of encephalopathy was assessed
at presentation using Glasgow's coma score. All patients were followed up until discharge to evaluate the outcome.
Result: A total of 5120 patients aged 1 month to less than 18 years were admitted, with 406 cases of NTC,
indicating a prevalence (406/5120) of 7.9%. Of the 406 patients, 194 (47.8%) were males. Their ages ranged from
3 months to 17 years (mean age, 6.13±5.10 years). The prevalence of NTC was higher among under five years old.
Fever (76.1%), convulsions (63.8%), and vomiting (53.2%) were the common complaints presented. Two hundred
and forty-one (59.4%) patients presented with mild encephalopathy. The primary causes of NTC were CNS
infection in 280 (69.0%), metabolic or toxic causes in 44 (10.8%), and epileptic causes in 27 (6.6%). Seventy-one
(17.5%) Patients died, while 319 (78.6%) were discharged. Among those discharged, 10.0% had mild disability,
3.4% severe disability, and 1.3% remained in a permanent vegetative state. The outcomes were influenced by sex,
level of encephalopathy at presentation, age, and the need for ICU care.
Conclusion: NTC is common in children, CNS infections, particularly cerebral malaria and meningitis, were the
predominant causes. Implementing measures to prevent these infections is important in our setting, where
resources are limited for adequate management.