Clinical Medicine Research

| Peer-Reviewed |

Non-traumatic Coma: Causes and Outcome of Adult Patients at University of Gondar Hospital, Northwest Ethiopia

Received: 08 November 2015    Accepted: 17 November 2015    Published: 10 December 2015
Views:       Downloads:

Share This Article

Abstract

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.

DOI 10.11648/j.cmr.20150406.16
Published in Clinical Medicine Research (Volume 4, Issue 6, November 2015)
Page(s) 198-203
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Focal Neurologic Deficit, Glasgow Coma Scale, Intoxication, Meningitis Syndrome

References
[1] Neilsonjn, R.W., Approach to the Altered Mental State. Internal Medicine Essentials for Clerkship Students 2, 2009: p. 231.
[2] Bates, D., Coma and brain stem death. Medicine, 2004. 32(10): p. 69-74.
[3] Sinclair, J.R., D.A. Watters, and A. Bagshaw, Non-traumatic coma in Zambia. Trop Doct, 1989. 19(1): p. 6-10.
[4] Allan H. Ropper, F.A., Braunwald E, Kasper , DL, Hauser SL, Longo DL, Jameson JL, Coma. 2008. 2: p. 1714-1719.
[5] Outcome of non-traumatic coma: Br Med J (Clin Res Ed). 1981 Jul 4; 283 (6283): 3-4.
[6] Huff JS, T.J., Kelen GD, Stapczynski JS, Altered mental status and coma. 2004: p. 1390.
[7] Young GB, A.M., Hockberger RS Stupor and coma in adults. UpToDate 17.3 2009.
[8] Kitchener, N., et al., Critical Care in in Neurology. 2012.
[9] 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.
[10] Levy, D.E., et al., Prognosis in nontraumatic coma. Ann Intern Med, 1981. 94(3): p. 293-301.
[11] Thacker, A.K., et al., Non-traumatic coma--profile and prognosis. J Assoc Physicians India, 1997. 45(4): p. 267-70.
[12] 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.
[13] 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.
[14] Forsberg, S., J. Hojer, and U. Ludwigs, Prognosis in patients presenting with non-traumatic coma. J Emerg Med, 2012. 42(3): p. 249-53.
[15] 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.
Author Information
  • Department of Internal Medicine, University of Gondar, Gondar, Ethiopia

  • Department of Internal Medicine, University of Gondar, Gondar, Ethiopia

  • Department of Internal Medicine, University of Gondar, Gondar, Ethiopia

  • Department of Internal Medicine, University of Gondar, Gondar, Ethiopia

  • College of Nursing, the Ohio State University, Ohio, U.S.A.

  • Department of Internal Medicine, University of Gondar, Gondar, Ethiopia

  • Department of Internal Medicine, University of Gondar, Gondar, Ethiopia

  • Department of Internal Medicine, University of Gondar, Gondar, Ethiopia

  • Department of Internal Medicine, University of Gondar, Gondar, Ethiopia

  • Department of Internal Medicine, University of Gondar, Gondar, Ethiopia

Cite This Article
  • APA Style

    Mohamed Abdulkadir Mohamed, Nebiyu Bekele, Ermias Diro, Ermias Shenkutie Greffie, Timothy Landers, et al. (2015). Non-traumatic Coma: Causes and Outcome of Adult Patients at University of Gondar Hospital, Northwest Ethiopia. Clinical Medicine Research, 4(6), 198-203. https://doi.org/10.11648/j.cmr.20150406.16

    Copy | Download

    ACS Style

    Mohamed Abdulkadir Mohamed; Nebiyu Bekele; Ermias Diro; Ermias Shenkutie Greffie; Timothy Landers, et al. Non-traumatic Coma: Causes and Outcome of Adult Patients at University of Gondar Hospital, Northwest Ethiopia. Clin. Med. Res. 2015, 4(6), 198-203. doi: 10.11648/j.cmr.20150406.16

    Copy | Download

    AMA Style

    Mohamed Abdulkadir Mohamed, Nebiyu Bekele, Ermias Diro, Ermias Shenkutie Greffie, Timothy Landers, et al. Non-traumatic Coma: Causes and Outcome of Adult Patients at University of Gondar Hospital, Northwest Ethiopia. Clin Med Res. 2015;4(6):198-203. doi: 10.11648/j.cmr.20150406.16

    Copy | Download

  • @article{10.11648/j.cmr.20150406.16,
      author = {Mohamed Abdulkadir Mohamed and Nebiyu Bekele and Ermias Diro and Ermias Shenkutie Greffie and Timothy Landers and Habtewold Shibiru and Helen Gebremedhin and Murad Muhammed and Omer Abdu and Tesfaye Yesuf},
      title = {Non-traumatic Coma: Causes and Outcome of Adult Patients at University of Gondar Hospital, Northwest Ethiopia},
      journal = {Clinical Medicine Research},
      volume = {4},
      number = {6},
      pages = {198-203},
      doi = {10.11648/j.cmr.20150406.16},
      url = {https://doi.org/10.11648/j.cmr.20150406.16},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.cmr.20150406.16},
      abstract = {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.},
     year = {2015}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Non-traumatic Coma: Causes and Outcome of Adult Patients at University of Gondar Hospital, Northwest Ethiopia
    AU  - Mohamed Abdulkadir Mohamed
    AU  - Nebiyu Bekele
    AU  - Ermias Diro
    AU  - Ermias Shenkutie Greffie
    AU  - Timothy Landers
    AU  - Habtewold Shibiru
    AU  - Helen Gebremedhin
    AU  - Murad Muhammed
    AU  - Omer Abdu
    AU  - Tesfaye Yesuf
    Y1  - 2015/12/10
    PY  - 2015
    N1  - https://doi.org/10.11648/j.cmr.20150406.16
    DO  - 10.11648/j.cmr.20150406.16
    T2  - Clinical Medicine Research
    JF  - Clinical Medicine Research
    JO  - Clinical Medicine Research
    SP  - 198
    EP  - 203
    PB  - Science Publishing Group
    SN  - 2326-9057
    UR  - https://doi.org/10.11648/j.cmr.20150406.16
    AB  - 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.
    VL  - 4
    IS  - 6
    ER  - 

    Copy | Download

  • Sections