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Disability after encephalitis: development and validation of a new outcome score
Penny Lewthwaite1, Ashia Begum, Mong How Ooi
1University of Liverpool, England. pennylewthwaite@doctors.org.uk
Insights
A new tool effectively assesses disability in children after Japanese encephalitis, predicting dependency with high accuracy. This simple Japanese encephalitis outcome score aids clinical evaluation.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Disability Assessment
Background:
- Japanese encephalitis (JE) poses a significant threat to children's neurological health.
- Assessing long-term disability and dependency after JE is crucial for patient management.
- Existing assessment tools may lack simplicity or comprehensive evaluation.
Purpose of the Study:
- To develop and validate a straightforward tool for assessing disability severity in children post-Japanese encephalitis.
- To determine the tool's ability to predict likely dependency in affected children.
Main Methods:
- A 15-item questionnaire-based outcome score was developed through literature review, expert consultation, and pilot testing.
- The score was applied to 100 children in Malaysia and 95 in India, including JE patients and controls.
- Inter- and intra-observer variability and agreement with clinical assessment were evaluated.
Main Results:
- Excellent inter-observer (Kappa 0.786-0.942) and intra-observer (Kappa 0.902-1.000) agreement was achieved.
- The tool demonstrated high sensitivity (100%) and specificity (93.8%-98.4%) in identifying dependent children.
- Agreement between the new score and clinical assessment was strong (Kappa 0.762-0.906).
Conclusions:
- The developed tool is simple to use for assessing disability after Japanese encephalitis.
- The outcome score shows good correlation with clinical assessments, aiding in dependency prediction.
Objective:
To develop a simple tool for assessing the severity of disability resulting from Japanese encephalitis and whether, as a result, a child is likely to be dependent.
Methods:
A new outcome score based on a 15-item questionnaire was developed after a literature review, examination of current assessment tools, discussion with experts and a pilot study. The score was used to evaluate 100 children in Malaysia (56 Japanese encephalitis patients, 2 patients with encephalitis of unknown etiology and 42 controls) and 95 in India (36 Japanese encephalitis patients, 41 patients with encephalitis of unknown etiology and 18 controls). Inter- and intra-observer variability in the outcome score was determined and the score was compared with full clinical assessment.
Findings:
There was good inter-observer agreement on using the new score to identify likely dependency (Kappa = 0.942 for Malaysian children; Kappa = 0.786 for Indian children) and good intra-observer agreement (Kappa = 1.000 and 0.902, respectively). In addition, agreement between the new score and clinical assessment was also good (Kappa = 0.906 and 0.762, respectively). The sensitivity and specificity of the new score for identifying children likely to be dependent were 100% and 98.4% in Malaysia and 100% and 93.8% in India. Positive and negative predictive values were 84.2% and 100% in Malaysia and 65.6% and 100% in India.
Conclusion:
The new tool for assessing disability in children after Japanese encephalitis was simple to use and scores correlated well with clinical assessment.
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