Disability after encephalitis: development and validation of a new outcome score.
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.


RESULTS
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.


CONCLUSIONS
The new tool for assessing disability in children after Japanese encephalitis was simple to use and scores correlated well with clinical assessment.
Lewthwaite
Penny
P
University of Liverpool, England. pennylewthwaite@doctors.org.uk
Begum
Ashia
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Ooi
Mong How
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Faragher
Brian
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Lai
Boon Foo
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Sandaradura
Indunil
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Mohan
Anand
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Mandhan
Gaurav
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Meharwade
Pratibha
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Subhashini
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Abhishek
Gulia
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Asma
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Penkulinti
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Shankar
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Ravikumar
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Young
Carolyn
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Cardosa
Mary Jane
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Ravi
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Wong
See Chang
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Kneen
Rachel
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Solomon
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D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D006233:Persons with Disabilities; D004660:Encephalitis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007194:India; D008296:Malaysia; D008297:Male; D010865:Pilot Projects; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires / Q000592:standards*