Janaki Rama Raju S.D.1
BACKGROUND Coma is a serious and common condition where there is severe derangement of neurological function, which needs immediate critical-care attention. Prognosis is good in patients with non-traumatic coma because of advances in medical care. Determination of the cause of non-traumatic coma is a challenge for the physician. It is important to discriminate between structural causes and non-structural causes. The simple clinical assessment of neurological function with special reference to the level of coma, focal neurological signs, and brainstem reflexes may predict the prognosis. Our study aimed to analyse the aetiology of nontraumatic coma and various factors that influence the prognosis. METHODS One hundred patients with non-traumatic coma were recruited in our study. History of illness was obtained through all the available sources and then the clinical examination was done at regular intervals with the special focus on Glasgow Coma Scale (GCS). All clinical findings were recorded as per the proforma in Excel sheet and analyzed with the Statistical Package for the Social Sciences (SPSS). All patients were followed till their recovery, discharge or death in our teaching hospital. Prognosis was correlated with aetiology, clinical features and GCS. RESULTS Out of 100 patients, 63 were male and 37 were female. Cerebro-Vascular Accident (CVA) was the commonest cause of coma (65%) followed by infections (20%) and metabolic disorders (10%). Onset of coma was significantly associated with the prognosis of non-traumatic coma and the mortality was more in patients with abrupt onset of coma (p > 0.05). CONCLUSIONS Cerebro-Vascular Accident is the major cause of non-traumatic coma, followed by infections. Mortality is high with intracranial aetiology when compared metabolic disorders. GCS score at the time of admission is the key predictor for the prognosis of non-traumatic coma. Status of brainstem reflexes will also help determining the prognosis.
