Disability after encephalitis : development and validation of a new outcome score.

Lewthwaite, Penny and Begum, Ashia and Ooi, Mong How and Faragher, Brian and Lai, Boon Foo and Sandaradura, Indunil and Mohan, Anand and Mandhan, Gaurav and Meharwade, Pratibha and Subhashini, S and Abhishek, Gulia and Begum, Asma and Penkulinti, Srihari and Shankar, M Veera and Ravikumar, R and Young, Carolyn and Cardosa, Mary Jane and Ravi, V and Wong, See Chang and Kneen, Rachel and Solomon, Tom (2010) Disability after encephalitis : development and validation of a new outcome score. Bull World Health Organ, 88 (8). pp. 584-592. ISSN 0042-9686

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Abstract

Objective : To develop a simple tool for assessing the severity of disability resulting from Japanese encephalitis and whether, as a result, a child is likely to be dependent. Methods : A new outcome score based on a 15-item questionnaire was developed after a literature review, examination of current assessment tools, discussion with experts and a pilot study. The score was used to evaluate 100 children in Malaysia (56 Japanese encephalitis patients, 2 patients with encephalitis of unknown etiology and 42 controls) and 95 in India (36 Japanese encephalitis patients, 41 patients with encephalitis of unknown etiology and 18 controls). Inter- and intra-observer variability in the outcome score was determined and the score was compared with full clinical assessment. Findings: There was good inter-observer agreement on using the new score to identify likely dependency (Κ=0.942 for Malaysian children; Κ=0.786 for Indian children) and good intra-observer agreement (Κ=1.000 and 0.902, respectively). In addition, agreement between the new score and clinical assessment was also good (Κ=0.906 and 0.762, respectively). The sensitivity and specificity of the new score for identifying children likely to be dependent were 100% and 98.4% in Malaysia and 100% and 93.8% in India. Positive and negative predictive values were 84.2% and 100% in Malaysia and 65.6% and 100% in India. Conclusion The new tool for assessing disability in children after Japanese encephalitis was simple to use and scores correlated well with clinical assessment.

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