Long-Term Outcomes and Risk Factors Associated With Acute Encephalitis in Children
Long-Term Outcomes and Risk Factors Associated With Acute Encephalitis in Children
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DOI：
10.1093/jpids/piv075
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发表时间：
2017-03-01
影响因子：
3.2
通讯作者：
Wilson, Karen M.
中科院分区：
文献类型：
--
作者：
Rao, Suchitra;Elkon, Benjamin;Wilson, Karen M.
背景资料。与脑炎儿童预后不良相关的因素还不是很清楚。我们试图确定脑电(EEG)结果、磁共振成像(MRI)异常或出现癫痫发作是否与不良结局相关。对2000年至2010年间收治的符合脑炎诊断标准的0至21岁患者进行了回顾性研究。与符合条件的儿童的父母联系并完成2份问卷，评估目前的身体和情感生活质量以及出院后至少1年的神经功能缺陷。在研究期间，我们确定了142名符合国际疾病分类第9版诊断为脑膜炎、脑膜脑炎或脑炎的患者。在这些患者中，114人符合脑炎诊断标准，其中76人(代表77人住院)有完整的数据可用。49例(%)患者获得随访。住进重症监护病房的患者更有可能出现异常的脑电结果(P=.001)。入院时癫痫发作的存在与后续持续的癫痫发作障碍有关。住院一年或多年后，78%的患者有持续性症状，包括35%的患者癫痫发作。4例(5%)患者死亡。MRI异常表现和首次出现异常发现的数量与较低的生活质量评分相关。脑炎导致严重的发病率和死亡率，大多数住院患者都实现了不完全恢复。危重患儿脑电结果异常更常见，MRI结果异常的患者在随访时的生活质量评分较低，入院时癫痫的存在与持续的癫痫发作障碍和较低的身体生活质量评分有关。
Background. Factors associated with poor outcomes of children with encephalitis are not well known. We sought to determine whether electroencephalography (EEG) findings, magnetic resonance imaging (MRI) abnormalities, or the presence of seizures at presentation were associated with poor outcomes.Methods. A retrospective review of patients aged 0 to 21 years who met criteria for a diagnosis of encephalitis admitted between 2000 and 2010 was conducted. Parents of eligible children were contacted and completed 2 questionnaires that assessed current physical and emotional quality of life and neurological deficits at least 1 year after discharge.Results. During the study period, we identified 142 patients with an International Classification of Diseases 9th Revision diagnosis of meningitis, meningoencephalitis, or encephalitis. Of these patients, 114 met criteria for a diagnosis of encephalitis, and 76 of these patients (representing 77 hospitalizations) had complete data available. Forty-nine (64%) patients were available for follow-up. Patients admitted to the intensive care unit were more likely to have abnormal EEG results (P = .001). The presence of seizures on admission was associated with ongoing seizure disorder at follow-up. One or more years after hospitalization, 78% of the patients had persistent symptoms, including 35% with seizures. Four (5%) of the patients died. Abnormal MRI findings and the number of abnormal findings on initial presentation were associated with lower quality-of-life scores.Conclusions. Encephalitis leads to significant morbidity and death, and incomplete recovery is achieved in the majority of hospitalized patients. Abnormal EEG results were found more frequently in critically ill children, patients with abnormal MRI results had lower quality-of-life scores on follow-up, and the presence of seizures on admission was associated with ongoing seizure disorder and lower physical quality-of-life scores.