Extent of disability among paediatric Japanese encephalitis survivors and predictors of poor outcome: a retrospective cohort study in North India.
BMJ Open
; 12(10): e060795, 2022 10 31.
Article
in En
| MEDLINE
| ID: mdl-36316071
ABSTRACT
OBJECTIVE:
To determine the Japanese encephalitis (JE)-associated long-term functional and neurological outcomes, the extent of reduced social participation and predictors of poor outcomes among paediatric JE survivors.DESIGN:
A retrospective cohort study.SETTING:
Laboratory-confirmed JE-positive paediatric cases (<16 years of age) hospitalised at the paediatric ward of Baba Raghav Das Medical College, Gorakhpur, India, between 1 January 2017 and 31 December 2017, were followed up after 6-12 months of hospital discharge.PARTICIPANTS:
126 patients were included in the study; median age was 7.5 years (range 1.5-15 years), and 74 (58.73%) were male. OUTCOMEMEASURES:
Functional outcome defined by Liverpool Outcome Score (LOS) dichotomised into poor (LOS=1-2) and good (LOS=3-5) outcome groups compared for demographic, clinical and biochemical parameters for prognostic factors of poor outcomes. Social participation of patients scaled on Child and Adolescent Scale of Participation score 2-5.RESULTS:
About 94 of 126 (74.6%) children developed neurological sequelae at different levels of severity. Age-expected social participation was compromised in 90 out of 118 children. In multivariate logistic regression analysis, a combination of parameters, JE unvaccinated status (OR 61.03, 95% CI (14.10 to 264); p<0.001), low Glasgow Coma Score (GCS) at admission (≤8) (OR 8.6, 95% CI (1.3 to 57.1); p=0.026), malnutrition (OR 13.56, 95% CI (2.77 to 66.46); p=0.001) and requirement of endotracheal intubation (OR 5.43, 95% CI (1.20 to 24.44); p=0.027) statistically significantly predicted the poor outcome with 77.8% sensitivity and 94.6% specificity. The goodness-of-fit test showed that the model fit well (Hosmer-Lemeshow goodness-of-fit test) (χ 2=3.13, p=0.988), and area under the receiver operating characteristic curve was 0.950.CONCLUSION:
This study estimates the burden of JE-presenting post-discharge deaths (15.4%) and disability (63.08%). Those who did not receive JE vaccine, were suffering from malnutrition, had GCS ≤8 at admission and required endotracheal intubation had poorer outcomes.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Encephalitis, Japanese
/
Malnutrition
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adolescent
/
Child
/
Female
/
Humans
/
Infant
/
Male
Language:
En
Journal:
BMJ Open
Year:
2022
Type:
Article
Affiliation country:
India