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Predictive factors of short-term neurologic outcome in children with encephalitis
S K Klein1, D L Hom, M R Anderson
1Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Childrens Hospital, Cleveland, Ohio.
Insights
Focal signs on neurologic examination and abnormal neuroimaging studies are key predictors of poor short-term outcomes in children with presumed encephalitis. These factors aid physicians in assessing prognosis upon hospital admission.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Clinical Medicine
Background:
- Physicians need clinical criteria to assess hospital care levels and prognosis for children with presumed encephalitis due to unknown etiology.
- Early identification of prognostic factors is crucial for managing pediatric encephalitis cases.
Purpose of the Study:
- To identify clinical factors at hospital admission that predict short-term outcomes in children with presumed encephalitis.
- To guide physicians in preliminary outcome assessments for families.
Main Methods:
- Retrospective review of 106 children (1 month to 20 years) diagnosed with encephalitis between 1978-1989.
- Analysis of clinical factors at admission, including neurologic examination, neuroimaging, Glasgow Coma Scale, and laboratory findings.
- Defined poor short-term outcome as an abnormal neurologic examination at hospital discharge.
Main Results:
- Focal signs on neurologic examination (OR: 16.30) and abnormal neuroimaging studies (OR: 5.66) were significant predictors of poor short-term outcome.
- Glasgow Coma Scale was only predictive when profoundly depressed (≤6); otherwise, it was not a useful prognostic tool.
- Age, seizures, status epilepticus, electroencephalographic abnormalities, and cerebrospinal fluid findings did not correlate with adverse outcomes.
Conclusions:
- Focal neurologic signs and abnormal neuroimaging are critical indicators for predicting poor short-term outcomes in pediatric encephalitis.
- Clinical assessment at admission, focusing on specific neurologic findings, is vital for prognosis.
- Further research may refine prognostic models for better patient management.
Abstract:
When a child is admitted to the hospital with presumed encephalitis, the physician must use clinical criteria to gauge the appropriate level of hospital care and to give a preliminary assessment of outcome to the family because the etiology is unknown. This study attempted to determine which clinical factors gathered on hospital admission would be most helpful to the physician. The records of 106 children (ages 1 month to 20 years), admitted to Rainbow Babies and Childrens Hospital between 1978-1989 who had discharge diagnoses of encephalitis, were reviewed. Seventy-five met the case definition of presumed viral encephalitis, with viral etiology established in 23% of patients. Poor short-term outcome was defined as the presence of an abnormal neurologic examination at hospital discharge, and was present in 32% of patients. Focal signs on neurologic examination (odds risk: 16.30, P < .05) and abnormal neuroimaging studies (odds risk: 5.66, P < .05) were the only 2 factors present at admission that predicted a poor short-term outcome. Glasgow coma scale at admission was predictive of an abnormal neurologic examination at discharge only when profoundly depressed (6 or less); otherwise, this scale was not useful as a prognostic tool. Factors that were not correlated with adverse outcomes included age younger than 1 year, any type of seizure occurrence, status epilepticus, diffuse or focal electroencephalographic abnormalities, or abnormal cerebrospinal fluid findings.(ABSTRACT TRUNCATED AT 250 WORDS)