The functional, social and economic impact of acute encephalitis syndrome in Nepal--a longitudinal follow-up study.

notes: PMCID: PMC3772013Open Access JournalOver 133,000 children present to hospitals with Acute Encephalitis Syndrome (AES) annually in Asia. Japanese encephalitis (JE) accounts for approximately one-quarter of cases; in most cases no pathogen is identified and management is supportive. Although JE is known to result in neurological impairment, few studies have examined the wider impact of JE and AES on patients and their families.Wellcome TrustUniversity of Liverpool Clinical Fellowshi

Educational and economic data among the 54 families interviewed, grouped by Liverpool Outcome Score.

<p>Results presented as number in each group with proportion (%) or Median (range) grouped by Liverpool outcome score (LOS) at follow-up; LOS 2 or 3 represents Severe or Moderate impairment; LOS 4 or 5 represents Mild or No Impairment; US$, United Sates Dollars.</p>*§‡<p>Significant difference in median values or proportion of patients between ‘LOS 2 or 3’ and ‘LOS 4 or 5’ groups (p = 0.048*, p = 0.004^§ and p = 0.007^‡ respectively). Significance measured via Mann Whitney U or Fisher's Exact Test.</p>†<p>15 participants provided specific information on admission medication cost.</p>¶<p>29 participants provided information on discharge medication costs.</p

Comparison of neurological impairment experienced by children at follow-up classified with JE or ‘Other AES’.

<p>Graph displays proportions (%) of the different types of neurological impairment experienced by children that were alive at follow-up after hospitalisation with AES (n = 66). Children were classified as suffering from JE or ‘Other AES’ based on their anti-JE virus antibody titres measured during acute admission (see <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002383#s2" target="_blank">Methods</a>). Neurological impairment was identified by reviewing clinician based on the history. White bars; JE patients (n = 19). Black bars; ‘other AES’ patients (n = 47).</p

Baseline characteristics for all patients with Acute Encephalitis Syndrome eligible for study inclusion.

<p>Characteristics presented as number (%) or median (range).</p><p>AES, Acute Encephalitis Syndrome; No., number; GCS, modified Glasgow coma scale (score 3–15); LOS, Liverpool Outcome Score (1 [died] – 5 [no impairment]); na, not applicable.</p>*<p>Significant difference in the median age among patients Followed and Not Followed up, p = 0.029.</p>‡<p>Discharge GCS was not available for 3 patients who were followed up.</p>¶<p>Discharge LOS was not available for 25 patients (19 followed up and 6 not).</p

Comparison of neurological impairment experienced by children with AES at discharge and at follow-up.

<p>Graph displays proportions (%) of the different types of neurological impairment experienced by children alive at discharge and at follow-up who had a Liverpool Outcome Score measured at both time-points (n = 50). Neurological impairment was identified by reviewing clinician based on the history. White bars; Problem at follow-up. Black bars; Problem at discharge. * Significant difference (P<0.05) in the proportion of children who exhibited a specific type of neurological impairment at discharge and at follow-up. Significance was measured by Fisher's exact test.</p

Flow diagram of study participants' recruitment and follow-up.

<p>All children admitted to hospital fitting WHO criteria for AES who were alive at discharge were attempted to be followed-up (n = 96). Seventy-two families were successfully contacted. Among these families, six children had died and 1 declined to participate further. The remaining 66 children participated in follow-up.</p