Etiology and short outcome of impairment of consciousness in children admitted to pediatric intensive care unit in Tabriz

Abstract

Finding out the most prevalent etiologies of impaired consciousness will impressively diminish mortality and morbidity by improving the treatment strategies. Our goals were determining the etiology of consciousness disorder in cases hospitalized in pediatric intensive care unit (PICU) and evaluating the short-term outcome in one-month and three-month follow‑up after discharge. Materials and methods: This study was conducted on comatose children from one month to 15 years old admitted to the intensive care unit (PICU) of Tabriz Children's Hospital from February 2020 to February 2021. The required information from the clinical records of the patients including age, gender, etiology of consciousness disorder, previous neurological or non-neurological disease, duration of consciousness disorder and hospitalization, FOUR score, GCS and GOSE were collected and the results were statistically analyzed. Results: We enrolled 85 patients, mean (±SEM) age was 53.7 (± 5.3) months, and 54.1% were male. The most prevalent causes of impaired consciousness were infectious or inflammatory diseases and metabolic disorders, both of which were observed in 15 patients (17.6%). A total of 29 (34.1%) patients expired. A significant relationship was observed between the cause of metabolic diseases and gender in the studied population, so that it was seen three times in the female than in the male. Age had a significant relationship with the cause of non-traumatic structural abnormalities. No significant relationship was observed between age and short-term prognosis of decreased level of consciousness. The mean of GOSE was significantly different between male and female (p<0.001) and the number of deaths was slightly higher in females than in males. In examining the causes of decreased alertness and short-term prognosis, it was found that in the causes of traumatic structural, the increase of GOSE in the traumatic structural group is more than the other group. In the causes of Hypoxic-Ischemic Encephalopathy, there was a significant difference in the mean of GOSE in two groups (p=0.005) and the patients not affected by HIE had a greater increase in GOSE than the patients with HIE. In the causes of metabolic disorders, the mean of GOSE was significantly different between the two groups (p=0.006) and the group with metabolic disorders showed a greater increase in GOSE than the other group. The prominent cause of mortality was non-traumatic structural(11 people, 78.6%). The longer the duration of the loss of consciousness, the lower the GOSE score will be for visits one month and three months later. There is a significant relationship between the GCS score and Four Score at the time of patient admission and the patient's prognosis in one-month and three-month follow‑up. In examining the relationship between EEG and imaging results and short-term prognosis, it was shown that there was no significant difference between the two groups in terms of GOSE average. In children with brain death, there is a significantly higher incidence of non-traumatic structural abnormalities in female and HIE in male than the opposite sex. The most common causative mechanism of brain death was hypoxic-ischemic injury owing to cardiac arrest.