Outcome of Non-Traumatic Encephalopathy in Children Admitted to Pediatric Intensive Care Unit

Background: Non Traumatic Coma (NTC) in children is a common cause of admission in pediatric Emergency Departments and is reported to result in high morbidity and mortality. Various etiological factors have been identified for NTC; however considerable regional diversity exists in these etiological factors. The data from developing countries cannot be generalized until more researches are reported from several different areas.Aim of the Work: To assess the outcome of non-traumatic encephalopathy and its prognostic factors in the Pediatric Intensive Care Unit (PICU) at Cairo University Children Hospital.Patients and Methods: This prospective observational study was conducted in the Pediatric Intensive Care Unit (PICU) of the Children Hospital at Cairo University over a period of 1 year. The study included 150 patients admitted in the PICU due to disturbed consciousness. All patients were subjected to detailed history-taking and thorough clinical (especially neurologic) examination. For all cases, routine investigations were done in addition to other investigations according to the results of history and examination. Outcome was recorded as survived and died. Those who survived were further divided into normal and disabled. Those with disability were divided into mild, moderate and severe disability.Results: The majority of our patients were aged between one month and three years (N=110=73.3%). Eighty-one patients (81) were males representing 54% of cases and sixty-nine patients (69) were females representing 46% of cases. The total mortality rate was 29.3%. Out of the 106 survivors; 56 were normal (without any neurological deficit) while 50 had some form of disability. By logistic regression, at admission: Low Glasgow coma score and longer periods of disease before referral were associated with higher mortality rates. Abnormal respiratory pattern and the presence of seizures at 48 hours after admission were independent significant predictors of mortality. Abnormal motor pattern was a significant predictor of disability.Conclusion: Early referral to Emergency Department and proper management are associated with better prognosis. GCS is a good predictive indicator of the outcome. Many risk factors can be used to categorize patients presenting to PICU into low or high risk groups such as the age of the patient, period of disease before referral, length of stay in the unit, motor pattern and seizures.