[P1-21] Description of Clinical Course and Predictive Score in Fatal Acute Encephalopathy
[Objectives] The detailed clinical course of fatal acute encephalopathy has been poorly understood. The objectives of this study were to describe their detailed clinical course and estimate the predicted death rate on admission using common index including APACHEⅡ, PIM2, and PELOD.
[Methods] We retrospectively reviewed the medical records of 5 patients (6 months to 14 years) who: 1) previously had no neurological disorders, 2) diagnosed as acute encephalopathy, and 3) left hospital mortality between October 2002 and March 2015 at Kobe Children’s Hospital.
[Results] The initial neurological symptom was convulsion (3 patients) or impaired consciousness (2 patients). An abnormality on the initial head CT was detected in only 1 patient. 4 patients developed shock and DIC at 4-13 hours after onset. Steroid pulse therapy in 3 patients and targeted temperature management in 1 patient were administered at 3-9 hours of onset. They were diagnosed as HSES in 2 patients, ANE in 1 patient, and Reye-like syndrome in 2 patients at 1-11hours of onset. The state of clinical brain death was declared from 8 hours to 4 days after onset. The predicted death rate on admission were 67-87% in APACHEⅡ, 2.6-80.5% in PIM2, and 20.8-100% in PELOD.
[Discussions] Most cases of fatal acute encephalopathy developed shock and DIC within several hours from onset. The initial head CT rarely leads the definite diagnosis. APACHEⅡ may be most useful to predict mortality among various predictive scores.
[Methods] We retrospectively reviewed the medical records of 5 patients (6 months to 14 years) who: 1) previously had no neurological disorders, 2) diagnosed as acute encephalopathy, and 3) left hospital mortality between October 2002 and March 2015 at Kobe Children’s Hospital.
[Results] The initial neurological symptom was convulsion (3 patients) or impaired consciousness (2 patients). An abnormality on the initial head CT was detected in only 1 patient. 4 patients developed shock and DIC at 4-13 hours after onset. Steroid pulse therapy in 3 patients and targeted temperature management in 1 patient were administered at 3-9 hours of onset. They were diagnosed as HSES in 2 patients, ANE in 1 patient, and Reye-like syndrome in 2 patients at 1-11hours of onset. The state of clinical brain death was declared from 8 hours to 4 days after onset. The predicted death rate on admission were 67-87% in APACHEⅡ, 2.6-80.5% in PIM2, and 20.8-100% in PELOD.
[Discussions] Most cases of fatal acute encephalopathy developed shock and DIC within several hours from onset. The initial head CT rarely leads the definite diagnosis. APACHEⅡ may be most useful to predict mortality among various predictive scores.