Comparison of functional outcome scales in paediatric acute encephalitis: Responsiveness and outcome predictors
Jia Hui Teo1, Sheru Shabhani2, Fan Qiao2
1Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
Insights
The WeeFIM (Wee Functional Independence Measure) score effectively captures early recovery in pediatric acute encephalitis patients. Autonomic dysfunction and movement disorders predict poorer outcomes at one month.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Clinical Outcomes Research
Background:
- Acute encephalitis poses significant challenges in assessing pediatric recovery.
- Standardized functional outcome measures are crucial for evaluating treatment efficacy and patient prognosis.
- Understanding predictors of short-term recovery aids in early intervention and management strategies.
Purpose of the Study:
- To compare the efficacy of different scoring systems in assessing short- and long-term recovery in pediatric acute encephalitis.
- To identify clinical predictors associated with short-term functional outcomes one month post-diagnosis.
- To evaluate the responsiveness and ceiling effects of various functional outcome measures.
Main Methods:
- Retrospective cohort study of pediatric patients diagnosed with acute encephalitis between July 2011 and 2016.
- Utilized Granerod's criteria for diagnosis and assessed functional outcomes using WeeFIM, LOS, GOS-E, mRS, and ICF scores at multiple time points (baseline, 1, 3, 6, 12 months).
- Performed univariate and multivariate analyses to identify predictors of one-month functional outcomes.
Main Results:
- Both WeeFIM (Wee Functional Independence Measure) and LOS (Length of Stay) scores demonstrated the most significant changes within the initial three months, indicating the period of highest recovery.
- The WeeFIM showed the most substantial improvement within the first month post-diagnosis.
- Univariate analysis revealed that seizure frequency in the first month, presence of movement disorders, autonomic dysfunction, and lower baseline functional scores were linked to poorer one-month WeeFIM scores. Autonomic dysfunction, movement disorders, and lower baseline scores remained significant predictors in multivariate analysis.
Conclusions:
- The WeeFIM is a potentially preferred functional outcome assessment tool due to its high responsiveness and low ceiling effect, capturing significant recovery early on.
- The presence of autonomic dysfunction and movement disorders at the time of diagnosis are significant clinical predictors of poorer functional outcomes at one month post-diagnosis in pediatric acute encephalitis.
Purpose:
To compare scoring systems and their ability to capture short and long-term recovery of paediatric patients with acute encephalitis. To identify clinical predictors of short-term outcomes by correlating functional outcome measures at 1 month post diagnosis of acute encephalitis.
Methods:
Patients with encephalitis diagnosed between July 2011 and 2016 based on Granerod's criteria were studied in this retrospective cohort study. Functional outcome scores on WeeFIM, LOS, GOS-E, mRS and ICF at initial presentation and 1, 3, 6 and 12 months later were compared.
Results:
WeeFIM and LOS scores both showed maximum change in the first 3 months, reflecting highest recovery in this period. With WeeFIM, the greatest change occurred within the first month following diagnosis. On univariate analysis, seizure frequency in the first month, presence of movement disorder, presence of autonomic dysfunction and lower baseline functional score was associated with poorer WeeFIM scores at 1 month. The latter three variables remained statistically significant on multivariate analysis.
Conclusion:
WeeFIM is a potentially preferred functional outcome assessment tool as it demonstrated greatest recovery within the first month due to a trend of high responsiveness and relatively low ceiling effect. Presence of autonomic dysfunction and movement disorders at diagnosis correlated with poorer outcome at 1 month post diagnosis.
