Studying the Prognostic Value of Clinical, Electroencephalographic and Neuro-imaging Findings in Predicting Outcomes of Coma in Pediatric Patients

Coma in pediatric intensive care units (PICUs) carries high morbidity and mortality. Predicting outcomes remains a challenge, particularly due to limited data integrating clinical, electroencephalographic (EEG), and neuroimaging findings. Objectives: To evaluate the predictive value of clinical, EEG, and neuroimaging findings as predicting factors of coma in PICU. Methods: This is a prospective observational study that was conducted at Al-Hussein University Hospital over 18 months (April 2023- October 2024), including 50 children (2 months- 18 years) admitted with coma (Glasgow Coma Scale <12). Clinical, laboratory, and neurological assessments were performed. All patients underwent EEG and neuroimaging (CT/MRI). The Pediatric Risk of Mortality (PRISM III) score and Pediatric Cerebral Performance Category (PCPC) scale were used for outcome assessment. Results: Our results show that coma accounted for 15.5% (50/ 322) of PICU admissions. Etiologies included traumatic brain injury (20%), central nervous system (CNS) infections (18%), CNS autoimmune diseases (16%), status epilepticus (16%), and septic shock with multi-organ dysfunction syndrome (16%). Prognostic analysis revealed that hypothermia, prolonged capillary refill time, hypotension, hypoxia, a GCS ≤8, hypotonia, abnormal deep tendon reflexes, and abnormal pupillary examination, hypo- or hypernatremia, hypokalemia, hypocalcemia, and high BUN and creatinine, abnormal EEG background, structural lesions on neuroimaging, higher PRISM scores, the need for inotropes and mechanical ventilation duration were associated with poor outcomes.