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VOLUME 17 , ISSUE 4 ( August, 2013 ) > List of Articles

RESEARCH ARTICLE

Factors associated with death and predictors of 1-month mortality in nontraumatic coma in a tertiary hospital in Northwestern Nigeria

Lukman Femi Owolabi, Alhassan Datti Mohammed, Mahmoud Muazu Dalhat, Aliyu Ibrahim, Salisu Aliyu, Desola Shakirat Owolabi

Keywords : Coma, mortality, predictors

Citation Information : Owolabi LF, Mohammed AD, Dalhat MM, Ibrahim A, Aliyu S, Owolabi DS. Factors associated with death and predictors of 1-month mortality in nontraumatic coma in a tertiary hospital in Northwestern Nigeria. Indian J Crit Care Med 2013; 17 (4):219-223.

DOI: 10.4103/0972-5229.118422

License: CC BY-ND 3.0

Published Online: 00-08-2013

Copyright Statement:  Copyright © 2013; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Coma occurring in the course of an illness ordinarily implies a poor prognosis and early prognostication is important for treatment decisions. The study was undertaken to study the factors associated with mortality in nontraumatic coma in a tertiary institution. Materials and Methods: In this prospective observational study, adults with clinically confirmed coma Glasgow coma scale (GCS) score of ≤8, admitted consecutively to the emergency unit of a tertiary hospital in Northwestern Nigeria over a period of 18 months were recruited. Vital parameters, severity of coma by GCS and neurological signs were recorded. The etiology of coma was determined on the basis of history, clinical examination, and laboratory investigations. Outcome was determined within 1 month of onset of coma by patients′ death or survival. Results: A total of 194 patients (140 males and 54 females) were recruited with mean age was 53.7 ± 1.4. The predominant etiological factors were central nervous system (CNS) infections (28.9%), toxic and metabolic (28.9%), and stroke (23.7%). Overall, 1-month mortality was 49%. On univariate analysis, the factors that showed significant association with outcome were gender, blood pressure, GCS, breathing pattern, pupillary size, pupillary reaction, papiloedema, and abnormal posturing. Abnormal pupillary size, severe hypertension, and GCS score ≤5 were independent predictors of in-hospital 1-month mortality in nontraumatic coma. Conclusion: The independent important predictors of nontraumatic 1-month coma mortality in a developing country setting were GCS ≤ 5, abnormal pupillary size, and severe hypertension.


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  1. Bates D, Caronna JJ, Cartlidge NE, Knill-Jones RP, Levy DE, Shaw DA, et al. A prospective study of nontraumatic coma: Methods and results in 310 patients. Ann Neurol 1977;2:211-20.
  2. Levy DE, Bates D, Caronna JJ, Cartlidge NE, Knill-Jones RP, Lapinski RH, et al. Prognosis in nontraumatic coma. Ann Intern Med 1981;94:293-301.
  3. Obiako OR, Oparah S, Ogunniyi A. Causes of medical coma in adult patients at the University College Hospital, Ibadan Nigeria. Niger Postgrad Med J 2011;18:1-7.
  4. Diango D, Moghomaye M, Maiga Y, Beye SA, Dembele AS, Coulibaly Y, et al. Coma in the elderly: Etiological factors, management, and prognosis in the department of anesthesia and intensive care. Anesth Essays Res 2011;5:153-7.
  5. Owolabi LF, Nagoda M. Stroke in developing countries: Experience at Kano, Northwestern Nigeria. Sudan J Med Sci 2012;7:9-14.
  6. Owolabi LF, Shehu MY, Shehu MN, Fadare J. Pattern of neurological admissions in the tropics: Experience at Kano, Northwestern Nigeria. Ann Indian Acad Neurol 2010;13:167-70.
  7. Matuja WB, Matekere NJ. Causes and early prognosis of non-traumatic coma in Tanzania. Muhimbili Medical Centre experience. Trop Geogr Med 1987;39:330-5.
  8. Sinclair JR, Watters DA, Bagshaw A. Non-traumatic coma in Zambia. Trop Doct 1989;19:6-10.
  9. Obiako OR, Ogunniyi A, Anyebe E. Prognosis of non traumatic coma: The role of some socio-economic factors on its outcome in Ibadan, Nigeria. Ann Afr Med 2009;8:115-21.
  10. Forsberg S, Höjer J, Ludwigs U. Prognosis in patients presenting with non-traumatic coma. J Emerg Med 2012;42:249-53.
  11. Jennett B, Teasdale G, Braakman R, Minderhoud J, Heiden J, Kurze T. Prognosis of patients with severe head injury. Neurosurgery 1979;4:283-9.
  12. Fleminger S, Ponsford J. Long term outcome after traumatic brain injury. BMJ 2005;331:1419-20.
  13. Perel P, Edwards P, Wentz R, Roberts I. Systematic review of prognostic models in traumatic brain injury. BMC Med Inform Decis Mak 2006;6:38.
  14. Willemse-van Son AH, Ribbers GM, Verhagen AP, Stam HJ. Prognostic factors of long-term functioning and productivity after traumatic brain injury: A systematic review of prospective cohort studies. Clin Rehabil 2007;21:1024-37.
  15. Bansal A, Singhi SC, Singhi PD, Khandelwal N, Ramesh S. Non traumatic coma. Indian J Pediatr 2005;72:467-73.
  16. Tokuda Y, Nakazato N, Stein GH. Pupillary evaluation for differential diagnosis of coma. Postgrad Med J 2003;79:49-51.
  17. van den Berge JH, Schouten HJ, Boomstra S, van Drunen Littel S, Braakman R. Interobserver agreement in assessment of ocular signs in coma. J Neurol Neurosurg Psychiatry 1979;42:1163-8.
  18. Zafonte R, Hammond FM, Mann NR. Relationship between Glasgow coma scale and functional outcome. Am J Phys Med Rehabil 1996;75:364-9.
  19. Sacco RL, VanGool R, Mohr JP, Hauser WA. Nontraumatic coma: Glasgow coma score and coma etiology as predictors of 2-week outcome. Arch Neurol 1990;47:1181-4.
  20. Braakman R, Gelpke GJ, Habbema JD, Maas AI, Minderhoud JM. Systematic selection of prognostic features in patients with severe head injury. Neurosurgery 1980;6:362-70.
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