Non-traumatic Coma: Causes and Outcome of Adult Patients at University of Gondar Hospital, Northwest Ethiopia
Clinical Medicine Research
Volume 4, Issue 6, November 2015, Pages: 198-203
Received: Nov. 8, 2015;
Accepted: Nov. 17, 2015;
Published: Dec. 10, 2015
Views 4835 Downloads 96
Mohamed Abdulkadir Mohamed, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
Nebiyu Bekele, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
Ermias Diro, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
Ermias Shenkutie Greffie, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
Timothy Landers, College of Nursing, the Ohio State University, Ohio, U.S.A.
Habtewold Shibiru, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
Helen Gebremedhin, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
Murad Muhammed, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
Omer Abdu, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
Tesfaye Yesuf, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
Follow on us
Coma represents a serious, life-threatening medical condition which should be treated effectively. It is important to recognize the underlying causes of coma in order to provide timely medical treatment. There is dearth of data on causes of medical coma in adults in Africa. This research aimed at determining the cause and outcome of coma in University of Gondar Hospital. Methods: A prospective observational descriptive study was conducted from 01/01/2014 to 31/06/2014 G.C in University of Gondar Hospital. All consecutive non trauma patients admitted to the medical wards with a Glasgow Coma Scale of 8 or less were included. An interview administered questionnaire to patient attendants and neurologic examination were employed to collect data like sociodemographics and clinical features. All important laboratory tests and outcome data were documented at patient discharge. Verbal consent from attendants was taken. Data was entered to and analyzed using Epiinfo7. Result: A total of 53 patients constituting approximately 3.4% of the medical emergencies seen during the study period were included in the study. The most common cause of coma were diseases that cause no focal neurologic deficit (FND), occurring in 31 (58.5%) patients. Among the causes with non-localizing signs, the most common causes were intoxications, uremic and hepatic encephalopathies, occurring in 11 (20.8%), 7 (13.2%), and 5 (9.4%) of the patients, respectively. Organophosphate (malathion) poisoning was the most common agent of intoxication responsible for 9 patients out of 11. These were followed by diseases with FND and meningitis syndromes, occurring in 14 (26.4%) and 8 (15.1%) patients, respectively. Among the patients admitted with coma without FND, 17 (54.8%) of the patients died, 6 (19.3%) had disability and 8 (25.8%) patients were discharged with improvement. In contrast, among patients admitted with coma with FND, no patient was discharged with improvement, 7 (50%) died and 7 (50%) were disabled. Among patients admitted with meningitis syndrome, 4 (50%) died, 2 (25%) were disabled and 2 (25%) were discharged with improvement. Conclusion: Diseases presenting without focal neurologic deficit, including toxic and metabolic causes, are the most common causes of coma. Among these, the most common was malathion poisoning which is reversible with appropriate care. Meningitis syndrome was not found to be a prominent cause of coma. Medical coma, regardless of the etiology, was associated with high mortality rate.
Focal Neurologic Deficit, Glasgow Coma Scale, Intoxication, Meningitis Syndrome
To cite this article
Mohamed Abdulkadir Mohamed,
Ermias Shenkutie Greffie,
Non-traumatic Coma: Causes and Outcome of Adult Patients at University of Gondar Hospital, Northwest Ethiopia, Clinical Medicine Research.
Vol. 4, No. 6,
2015, pp. 198-203.
Copyright © 2015 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Neilsonjn, R.W., Approach to the Altered Mental State. Internal Medicine Essentials for Clerkship Students 2, 2009: p. 231.
Bates, D., Coma and brain stem death. Medicine, 2004. 32(10): p. 69-74.
Sinclair, J.R., D.A. Watters, and A. Bagshaw, Non-traumatic coma in Zambia. Trop Doct, 1989. 19(1): p. 6-10.
Allan H. Ropper, F.A., Braunwald E, Kasper , DL, Hauser SL, Longo DL, Jameson JL, Coma. 2008. 2: p. 1714-1719.
Outcome of non-traumatic coma: Br Med J (Clin Res Ed). 1981 Jul 4; 283 (6283): 3-4.
Huff JS, T.J., Kelen GD, Stapczynski JS, Altered mental status and coma. 2004: p. 1390.
Young GB, A.M., Hockberger RS Stupor and coma in adults. UpToDate 17.3 2009.
Kitchener, N., et al., Critical Care in in Neurology. 2012.
Obiako, O.R., S. Oparah, and A. Ogunniyi, Causes of medical coma in adult patients at the University College Hospital, Ibadan Nigeria. Niger Postgrad Med J, 2011. 18(1): p. 1-7.
Levy, D.E., et al., Prognosis in nontraumatic coma. Ann Intern Med, 1981. 94(3): p. 293-301.
Thacker, A.K., et al., Non-traumatic coma--profile and prognosis. J Assoc Physicians India, 1997. 45(4): p. 267-70.
Lukman, O.F., et al., Etiology and outcome of medical coma in a tertiary hospital in Northwestern Nigeria. Annals of Nigerian Medicine, 2012. 6(2): p. 92.
Matuja, W.B. and N.J. Matekere, Causes and early prognosis of non-traumatic coma in Tanzania. Muhimbili Medical Centre experience. Trop Geogr Med, 1987. 39(4): p. 330-5.
Forsberg, S., J. Hojer, and U. Ludwigs, Prognosis in patients presenting with non-traumatic coma. J Emerg Med, 2012. 42(3): p. 249-53.
Melka, A., R. Tekie-Haimanot, and M. Assefa, Aetiology and outcome of non-traumatic altered states of consciousness in north western Ethiopia. East African medical journal, 1997. 74(1): p. 49-53.