Outcome of nontraumatic coma in a Nigerian tertiary hospital

Abstract

Abstract 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 28"' 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.