Resum
Background: Coma occurring in the course of an illness traditionally implies a poor prognosis, but few data define the factors that affect its outcome. Although prognostication of coma is difficult because of the heterogeneity of the contributing diseases, ability to accurately predict the outcome of coma of any etiology will help families and health providers make appropriate decisions about continued medical care, especially for patients on life support.
Objective: To determine the outcome of nontraumatic coma in adult patients admitted at the University College Hospital (UCH), Ibadan, including the prognostic factors.
Method: Two hundred consecutive unconscious patients admitted at the medical emergency unit of UCH, from August 2004 to March 2005, were studied for a maximum of 28 days for functional outcome, using a structured protocol comprising clinical history, physical examination and results of relevant diagnostic investigations, although a study was terminated if death occurred before the 28th day.
Results: Sixty-six percent of the patients were males, 50% were aged 40-59 years, 26.5% (> 60 years), 23% (20- 39 years) and 0.5% (< 20 years) respectively. General outcome were: mortality rate (76%), vegetative state (2%), recovery with severe disability (6%), recovery with some disability (5%), and recovery with no disability (11%). Case fatality rates ranged from 100% (hepatic coma, HIV associated meningoencephalitis) to zero % (alcohol intoxication). Poor prognostic factors were presentations after 6 hours and inability to have relevant investigations performed.
Conclusion: Nontraumatic coma was associated with poor prognosis and outcome.
Keywords: Case fatality rate, Glasgow coma scale, mortality rate, outcome of non-traumatic coma.
Résumé
Le coma au cours d’une maladie implique traditionnellement un pauvre pronostic, mais quelques données définissent les facteurs qui affectent les résultats. Bien que la pronostication du coma soit difficile a cause de l’hétérogénéité des maladies contribuant, l’habilité de prédire justement le résultat du coma d’une étiologie aidera les familles et les professionnels de santé à prendre des décisions appropriées à propos des soins médicaux continus, Spécialement aux patients en soins intensif. Le but de cette étude était de déterminer le résultat du coma non traumatique chez les patients adultes admis au Centre Universitaire hospitalier (UCH), Ibadan, incluant les facteurs pronostiques. Deux cent patients consécutifs et inconscient admis dans l’unité du service d’urgence au CHU, d’Aout 2004 à Mars 2005, étaient étudiés Durant 28 jours pour un résultat fonctionnel en utilisant un protocole structurel incluant l’histoire clinique, l’examen physique et les résultats des examens d’investigations bien que l’étude était fini si le décès était enregistre avant 28 jours. Soixante six pourcent des patients de males, 50% étaient âgés entre 40-59 ans, 26.5% (e” 60 ans), 23% (20-39 ans) et 0.5% (< 20 ans) respectivement. Les taux de motilité totale étaient de (76%), état végétatif (2%), convalescent avec un handicap sévère (6%), convalescent avec quelques handicaps (5%), et convalescent sans handicap (11%). Les taux de fatalité variaient de 100% (coma hépatique, VIH associé a la méningo-encéphalite) à zéro % (intoxication alcoolique). Les faibles facteurs pronostiques étaient observés 6.heures après mais un manque des équipements d’investigations. En conclusion, le coma non traumatique était associé avec une faible pronostic et résultat.
Correspondence: Dr. O R Obiako,Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria. E-mail: reginaldobiako@yahoo.com.
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