مرکز منطقه ای اطلاع رساني علوم و فناوري - NON-INDUCED TRAUMATIC COMA IN CHILDREN IN NORTHERN REGION OF YEMEN Causes and Mortality

Abstract :

Objective : To describe the causes of noninduced traumatic coma (CNIT) in children in Yemen and to report the morbidity and mortality of such presentations. Methods: Cross-sectional study over a period of three years. Files of 150 children aged between one month and 14 years admitted with CNIT to the pediatric unit of Al-Salam Hospital, Saddah, Yemen, from July 2012 to July 2015, were reviewed. History, presenting symptoms, clinical and laboratory data were collected. Etiology of coma was determined on the basis of clinical history and relevant investigations. The outcome was recorded as death or neurological condition at discharge defined as normal, mild or sever disability. Chi-square test was used to test differences in categorical variables. Results: Out of 8967 children admitted during the study period,150 presented with coma giving an incidence rate of 1.67%. There were 87 (58%) boys and 63 (42%) girls. The mean ± SD age of patients was 2.7 ± 2.35 years. Systemic presentations including nausea, vomiting, fever, lethargy and poor feeding were more prominent in children 2 years. Etiology of coma in 60% cases was CNS infection (viral encephalitis : 30, bacterial meningitis : 24, cerebral malaria : 18) ; other causes were : toxic-metabolic conditions (16%), status epilepticus (10%), congenital brain malformation, hydrocephalus with V-P shunt (3.4%), and unknown (8%). Ninety-nine children survived, 39 were normal, 14 had mild disability, 32 had moderate disability and 14 were severely disabled and dependent. Survival was significantly better in patients with CNS infection (73.4%) as compared to those with toxic-metabolic causes (37%) and poisoning/intoxication (25%). Conclusion : CNS infections and toxic metabolic origins were the most common causes of coma noninduced trauma (CNIT) in childhood.