Assessment of Prognosis in Nontraumatic Coma in a Tropical Environment

Publisher Website
Google Scholar
Abstract
Nontraumatic coma in 93 patients admitted to the medical wards of Muhimbili Medical Centre, Dar es Salaam, was associated with a grave prognosis. The most important indicators of outcome were the cause of coma, the presence of early neurological signs, and the Glasgow Coma Scale score on admission and on subsequent days. Of 37 patients admitted with cerebral malaria 25 (67.6%) regained independent existence at one month, as well as 2 (50%) of 4 patients admitted in diabetic coma and 2 (22.2%) of 9 patients admitted with meningitis. Apart from one patient with status epilepticus no patient in any other diagnostic category achieved either moderate or complete recovery. The prognostic chart developed by Levy and colleagues was useful in identifying patients with a serious prognosis. The Glasgow Coma Scale, which is simpler to use, was also found useful and should be further tested to confirm its value for nonspecialist doctors required to manage patients presenting in nontraumatic coma in a tropical environment. While therapeutic facilities are limited in most developing countries, it is doubtful if the acquisition of expensive intensive care facilities would significantly improve prognosis for patients in nontraumatic coma. Emphasis should instead be placed on the recognition and effective treatment of those problems associated with nontraumatic coma for which specific and effective remedies are available.

This publication has 12 references indexed in Scilit: