Objective: To study the etiology and clinical profile of non-traumatic coma in children and to determine the predictors of outcome

Methods: one hundred and four consecutive children between 2mo – 12 yr were studied. The clinical signs at admission: vital signs, Glasgow coma scale, respiratory pattern, papillary reflex, extraocular movements, fundus picture and motor deficits were recorded. Etiology of coma was determined by clinical history, examination and relevant investigations. Their progress was monitored clinically, biochemically and with multisystem monitors. Outcome was recorded as survived or died. Chi-square and Fisher exact test were used to test the significance of study parameters. Multivariate logistic regression was used to find the predictors for outcome.

Results: Etiology of coma was intracranial infections in 65%, metabolic in 20% and others. Sixteen percent had residual neurodeficits, 16% died. Survival was better in children with intracranial infections (13%) as compared to metabolic coma (33%). On multivariate logistic regression, bradycardia, hypotension, abnormal respiratory pattern, duration of coma > 48 hrs, GCS < 7 at admission, unequal & non-reactive pupils, papilledema, abnormal extraocular movements, motor deficits, signs of meningitis correlated with mortality. Requirement of ventilatory support and abnormal CT findings correlated with mortality.

Conclusion: Intracranial infections were the most common cause; the most common cause of death being metabolic coma. Simple clinical signs and relevant investigations served as prognostic indicators of outcome.