title: Abnormal intra-aural pressure waves associated with death in African children with acute nontraumatic coma.
abstract: BACKGROUND
  We explored the relationship between tympanic membrane displacement (TMD) measurements, a tool to monitor intracranial pressure noninvasively, and clinical features and death in children with acute coma in Kilifi, Kenya.
  
  
  METHODS
  Between November 2007 and September 2009, we made serial TMD measurements and clinical observations on children with acute coma (Blantyre coma score (BCS) ≤ 2) on the pediatric high dependency unit of Kilifi District Hospital, and on well children presenting to the hospital's outpatient department for routine follow-up. We examined middle ear function using tympanometry and measured cardiac pulse (CPA) and respiratory pulse pressure amplitudes (RPA) using the TMD analyzer.
  
  
  RESULTS
  We recruited 75 children (32 (43%) females; median age 3.3 (IQR: 2.0, 4.3) years). Twenty-one (28%) children died. Higher TMD measurements predicted death. Adjusting for diagnosis, every 50 nl rise in both semirecumbent and recumbent CPA was associated with increased odds of death associated with intracranial herniation (OR: 1.61, 95% confidence interval (CI): 1.07, 2.41; P = 0.02 and OR: 1.35, 95% CI: 1.10, 1.66; P ≤ 0.01 respectively).
  
  
  CONCLUSIONS
  Raised TMD pulse pressure measurements are associated with death and may be useful in detecting and monitoring risk of intracranial herniation and intracranial pressure in childhood coma.
authors: 1] Department of Medical Physiology, School of Medicine, Kenyatta University, Nairobi, Kenya [2] Clinical Research, Afya Research Africa, Nairobi, Kenya.
authors: Samson
authors: S
authors: Gwer
authors: Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya.
authors: Michael
authors: M
authors: Kazungu
authors: Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya.
authors: Eddie
authors: E
authors: Chengo
authors: Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK.
authors: Eric O
authors: EO
authors: Ohuma
authors: 1] Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya [2] Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, UK [3] Department of Paediatrics and Child Health, Mulago Teaching Hospital, Makerere University, Kampala, Uganda.
authors: Richard
authors: R
authors: Idro
authors: Neurological Physics Group, Department of Medical Physics and Bioengineering, Southampton University Hospital NHS Trust, Southampton, UK.
authors: Tony
authors: T
authors: Birch
authors: Neurological Physics Group, Department of Medical Physics and Bioengineering, Southampton University Hospital NHS Trust, Southampton, UK.
authors: Robert
authors: R
authors: Marchbanks
authors: 1] Neurosciences Unit, Institute of Child Health, University College of London, London, UK [2] Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors: Fenella J
authors: FJ
authors: Kirkham
authors: 1] Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya [2] Neurosciences Unit, Institute of Child Health, University College of London, London, UK [3] Department of Psychiatry, University of Oxford, Oxford, UK.
authors: Charles R
authors: CR
authors: Newton
mesh_terms: D000158:Acoustic Impedance Tests; D001794:Blood Pressure; D001927:Brain Diseases / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D007427:Intracranial Pressure; D007630:Kenya; D016779:Malaria, Cerebral / Q000401:mortality; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D015588:Observer Variation; D013997:Time Factors; D014432:Tympanic Membrane