Background:
Disorders of consciousness including coma can be caused by a wide variety of etiologies affecting the central nervous system. Severity of coma may vary according to the causes of coma and patient’s characteristics.
Objective:
To determine frequency of major causes of coma patients presented to Emergency Department (ED) of tertiary care hospitals in Qassim region of Saudi Arabia.
Methods:
This retrospective audit study consisting of cases of coma, presented with impaired conscious level of any age and either gender admitted through ED of tertiary care hospitals in X region of Saudi Arabia over past 2 years. Patients with transient impairment of conscious level, pregnant women, referred cases of multiple organ failure and no clear etiological diagnosis on discharge were excluded from the study. After ethical approval, the data of the patients were collected retrospectively from the medical records on structured Proforma (Annexure-1).
Results:
Out of 422 patients of coma, 96 (22.7%) were observed with severely reduced GCS (≤8 score). About 2/3rd of patients had non-traumatic causes of coma (NTC) out of this cerebral infarction (16.4%) and metabolic brain dysfunction (15.6%) were the major causes in age group >50 years. The most frequent single cause of altered mental status was traumatic brain injury (TBI) in 31% of cases with age group less the 40 years most affected 68%. Regarding the localization of coma, we observed; Diffuse brain dysfunction in 40% (n=169), Supra tentorial location in 44.8% (N=189) and infra tentorial localization in 15.2% (n=64) of cases, however the severe coma causes in older patients (>60 years) were infratentorial stroke, CNS infection, brain metastasis and brain anoxia (p60 years), infratentorial stroke, CNS infection, brain metastasis and brain anoxia.
Key words: Coma, etiology, frequency, non-traumatic coma, traumatic brain injury, coma localization.
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