Extent of disability among paediatric Japanese encephalitis survivors and predictors of poor outcome: a retrospective cohort study in North India

• Published in: BMJ open Vol. 12; no. 10; p. e060795
• Main Authors: Srivastava, Neha, Deval, Hirawati, Mittal, Mahima, Deoshatwar, Avinash, Bondre, Vijay P, Kant, Rajni, Yadav, Rajaram
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 31.10.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Cohort analysis; Encephalitis; Infectious Diseases; Intubation; Malnutrition; neurology; paediatric infectious disease & immunisation; paediatric neurology; Pediatrics; public health; Teenagers; India
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-060795

ObjectiveTo 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.DesignA retrospective cohort study.SettingLaboratory-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.Participants126 patients were included in the study; median age was 7.5 years (range: 1.5–15 years), and 74 (58.73%) were male.Outcome measuresFunctional 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.ResultsAbout 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) (χ2=3.13, p=0.988), and area under the receiver operating characteristic curve was 0.950.ConclusionThis 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.