944. Predictors of Outcome in Pediatric Encephalitis
Session: Poster Abstract Session: Central Nervous System Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Childhood encephalitis is a frustrating and sometimes devastating condition with an unpredictable prognosis. Little guidance exists for discussing potential outcomes with families. The purpose of this study is to identify predictors of outcome in pediatric encephalitis.

Methods: This is a retrospective cohort study focusing on patients with encephalitis referred to the California Encephalitis Project (CEP) from Children’s Hospital & Research Center Oakland (CHRCO) from January 1 1998 to December 31 2009. Demographic, clinical, laboratory, and neuroimaging data were collected by CEP. All other data were obtained by medical chart review. Outcomes were then classified into “recovered” (defined by complete or near complete neurologic recovery) or “not recovered” (defined by moderate-severe deficits or death). Outcomes were evaluated at 7-10 days after admission, at discharge, and at 3 and 12 months after discharge.  Logistic regression was used to identify predictors associated with recovery.  

Results: Evaluable outcomes were available at discharge for 158 of 197 patients (80%). One hundred and ten patients (70.0%) recovered at discharge, while 48 (30.0%) did not recover with 12 deaths (7.6%). Through logistic regression, Asian ethnicity, abnormal neuroimaging, and Glasgow Coma Score (GCS) were found to be significantly associated with outcomes at discharge. Specifically, patients of Asian ethnicity were less likely to recover when compared to patients of other ethnicities (RR=0.20, p value <0.01). Patients with abnormal neuroimaging studies were less likely to recover compared to patients with  normal neuroimaging (RR=0.41, p=0.01). Finally, patients with GCS > 5 were more likely to recover than patients with GCS < 6 (RR=7.98, p value <0.01). In a multivariable analysis, similar statistically significant findings were noted at 7-10 days after admission and at 3 and 12 months after discharge.

Conclusion: This study is unique in identification of ethnicity as an independent predictor of pediatric encephalitis outcomes. The association of Asian race with poor outcome is intriguing. Additional variables examined in this study may be useful ancillary tools to aid in predicting outcomes among children hospitalized with encephalitis.


Subject Category: P. Pediatric and perinatal infections

Kara DuBray, MD1,2, Andrew Anglemyer, PhD3, A. Desiree LaBeaud, MD, MS4, Heidi Flori, MD5, Sharon L. Messenger, PhD1, Christopher Preas, BA6, Heather Sheriff, BA7 and Carol Glaser, DVM, MPVM, MD7, (1)California Department of Public Health, Richmond, CA, (2)Children's Hospital & Research Center Oakland, Oakland, CA, (3)Pediatrics, Division of Infectious Diseases, Stanford University, Stanford, CA, (4)Pediatric Infectious Diseases, Children's Hospital and Research Center Oakland, Oakland, CA, (5)Children's Hospital and Research Center at Oakland, Oakland, CA, (6)California Department of Public Health, richmond, CA, (7)Communicable Disease Emergency Response Branch, California Department of Public Health, Richmond, CA

Disclosures:

K. DuBray, None

A. Anglemyer, None

A. D. LaBeaud, None

H. Flori, None

S. L. Messenger, None

C. Preas, None

H. Sheriff, None

C. Glaser, None

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