Coma in a pediatric intensive care unit: Clinicoetiological profile, management, and outcomes from a secondary care hospital in Northeast India

Abstract

Coma in children is a critical neurological emergency resulting from diverse etiologies and requiring intensive neuroprotective care. Data on pediatric coma from Northeast India are limited. This study aimed to describe the clinicoetiological profile, management, and outcomes of pediatric coma in a pediatric intensive care unit (PICU). This retrospective study included all children aged 1 month to 16 years admitted with coma to the PICU of a secondary care hospital in Northeast India between August 2019 and August 2023. Demographic, clinical, and management data were collected and analyzed using standard statistical tests. The primary outcome was in-hospital mortality; the secondary outcome was the degree of neurological disability at discharge. Of 448 PICU admissions, 47 (10.5%) children presented with coma. The median age was 48 months, and 55% were male. Central nervous system (CNS) infections accounted for 74.5% of cases, and traumatic brain injury accounted for 14.9%. Overall mortality was 12.7%, with no significant association between mortality and clinical or management factors. At discharge, 26.8% of children had no neurological deficit, 43.9% had mild, and 26.8% had severe disability. Severe disability was associated with longer PICU and hospital stay, prolonged mechanical ventilation, and extended duration of sedation and analgesia ( P < 0.05). CNS infections remain the leading cause of pediatric coma in this region. Although mortality was modest, a substantial proportion of survivors had neurological disability, emphasizing the need for standardized care and structured neurorehabilitation follow-up.