The Aetiology of Non-traumatic (Medical) Coma.

Abstract

Coma of unknown aetiology is a major contributor to emergency room admission figures around the World and accounts for an even larger share of hospital mortality figures. In the interest of an optimal outcome, speed in making a correct diagnosis and instituting emergency measures is required, and a prior familiarity with coma actiology is of great help. The aetiological audit of coma has been the subject of many studies in Western literature, but no such effort has been made in our country until now. This prospective study was prompted by the lack of indigenous statistics for common causes of non-traumatic coma in a tertiary care setup. One hundred and sixteen (males 67, females 49) patients, falling maximally (72%) in the age range of 21-60 years, with coma due to non- traumatic (medical) causes were included in the study, and their diagnosis was established using clinical, laboratory and radiological techniques. It was found that coma (hic to metabolic causes was the largest category (57%), followed by structural (28%), diffuse cerebral (12%), and psychogenic (3.4%) causes of coma. Cerebrovascular accidents (24%), poisoning (16%), coma due to hepatic (12%) and renal failure (11%), and diabetic coma (10%) were the leading individual causes in declining order. There is need to establish a Poisoning Information Centre and availability of toxicology analysis for better management of patients with coma (due to poisoning. Furthermore, measures should be taken to have a CT Scan of comatose patient promptly and free or on minimal charges.