Predictive factors of short-term neurologic outcome in children with encephalitis.
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)
Klein
S K
SK
Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Childrens Hospital, Cleveland, Ohio.
Hom
D L
DL
Anderson
M R
MR
Latrizza
A T
AT
Toltzis
P
P
D000293:Adolescent; D000328:Adult; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D004660:Encephalitis / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D018792:Encephalitis, Viral / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008297:Male; D009460:Neurologic Examination; D010343:Patient Admission; D011379:Prognosis; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology