Evaluating Non-Traumatic Loss of Consciousness in Children Admitted to the Emergency Room

Non-traumatic loss of consciousness is a nonspecific symptom resulting from a broad range of diseases in children, and its outcome depends on factors, including its primary etiologies, age, sex, and patient clinical condition at the time of admission. The purpose of this study was to evaluate the etiology and outcome of children's non-traumatic loss of consciousness and to determine predictive clinical and paraclinical features.

This retrospective cross-sectional study was conducted in Imam Hossein Hospital, Isfahan, Iran. Documents of 101 children aged one month to fifteen years old who were admitted with non-traumatic loss of consciousness from March 2016 to March 2017 were reviewed. Data regarding patient’s profile, signs and symptoms, para-clinical findings, progression, and outcome were collected and analyzed using SPSS software version 23.0.

Results showed that the most common cause was infections (40.6%), followed by seizure (23.8%) and intoxication (19.8%). Also, infection was the main cause of mortality. The mortality rate was 18.8% and it was significantly and directly correlated with duration of hospitalization, intensive care unit (ICU) admission, and emergency interventions such as intubation or cardiopulmonary resuscitation (CPR) at the time of admission, seizure status, dehydration, irritability, poor feeding, oliguria, hypotension, non-reactive pupils, low oxygen saturation, hyporeflexia, and hypotonia. Moreover, paraclinical factors such as thrombocytopenia, neutropenia, impaired liver and kidney function tests, and high coagulation test predicated poor outcomes.

The most common cause of non-traumatic loss of consciousness and the most common cause of mortality was infection. Longer duration of hospitalization, ICU admission and interventions were associated with poor outcomes. It seems physicians should pay more attention to these predictive factors.