Investigation of the etiological aspects of pediatric patients with acute impairment of consciousness

Impairment of consciousness is an emergent condition associated with high morbidity and mortality. Patients who developed impaired consciousness account for a significant number of emergency service admissions and the patients in intensive care units.Many disease may effect brain functions, leading to change in consciousness at various levels. It is compulsory to identify the etiology in order to provide the appropriate treatment and to predict prognosis. In addition to the etiology, some laboratory tests, electroencephalography (EEG), radiological findings and consequential complications may have prognostic value.In previous studies, traumatic and non-traumatic causes are often evaluated separately while investigating the etiology and prognosis. In this study, 250 patients who developed impairment of consciousness due to traumatic and non-traumatic causes are evaluated retrospectively.Trauma is most frequently observed structural cause (32%) when the etiology is analyzed. It is followed by intoxications, status epilepticus, infectious-inflammatory and metabolic-systemic factors, respectively. According to Glasgow outcome score, 72% of patients had full recovery, 12% were discharged with moderate or severe disability while 16% died. Risk factors for morbidity are found as; the presence of intracranial hemorrhage, infectious and inflammatory causes, convulsion longer than 1 hour duration, EEG abnormality and imaging of edema, diffuse axonal injury, demiyelination, leptomeningeal involvement, cortical/extracortical signal changes and hydrocephalus. Risk factors for mortality are determined as; the presence of neoplastic causes in the etiology, Glasgow coma score less than 8, imaging of subarachnoid hemorrhage, intraventricular hemorrhage, edema and infratentorial mass; hypotension, hyperglycemia, hyponatremia, hypernatremia, hypocalcemia, hypokalemia, anemia, prolonged prothrombin time, disseminated intravascular coagulation, low pH and requirement for positive inotropic agents and mechanic ventilation. High fever and sepsis are detected as the risk factors for both morbidity and mortality.Keywords: Acute impairment of consciousness, etiology, prognosis