PREDICTIVE FACTORS OF SHORT-TERM NEUROLOGIC OUTCOME IN CHILDREN WITH ENCEPHALITIS

When a child is admitted to the hospital with presumed encephalitis, t he physician must use clinical criteria to gauge the appropriate level of hospital care and to give a preliminary assessment of outcome to t he family because the etiology is unknown, This study attempted to det ermine which clinical factors gathered on hospital admission would be most helpful to the physician, The records of 106 children (ages 1 mon th to 20 years), admitted to Rainbow Babies and Childrens Hospital bet ween 1978-1989 who had discharge diagnoses of encephalitis, were revie wed. Seventy-five met the case definition of presumed viral encephalit is, with viral etiology established in 23% of patients, Poor shortterm outcome was defined as the presence of an abnormal neurologic examina tion at hospital discharge, and was present in 32% of patients. Focal signs on neurologic examination (odds risk: 16.30, P < .05) and abnorm al neuroimaging studies (odds risk: 5.66, P < .05) were the only 2 fac tors present at admission that predicted a poor short-term outcome, Gl asgow 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 tha t 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 cerebrospina l fluid findings, The findings suggest that careful neurologic examina tion with attention to focal signs and early neuroimaging studies are important data to obtain on hospital admission of children with presum ed encephalitis because they are helpful for planning hospital care an d assessing short-term outcome.