Neurological Function Evaluation And Prognosis Analysis Of Children With Consciousness Disorder

Part1 Meta analysis of early prognosis of Full Outline of Unresponsiveness for critically ill ChildrenObjective Systematic review and meta analysis were used to ev aluate the predictive effect of Four for critically ill childrenMethods We search systematically the databases to the progn osis evaluation of the comprehensive of the FOUR scale in se veral databases including Wanfang Data,CNKI,VIP,Pub Med,the Coc hrane Library and EMbase since 2005 for critically ill children.The two researchers independently screened the literature accordin g to the inclusion and exclusion criteria,used QUADAS tools to evaluate the quality of the literature,extracted data,and u sed META-DISC1.40 software for analysis.Results Finally,6 literatures were included,with 425 patients.T he sensitivity was 0.80(95%CI:0.69～0.88),the specificity was 0.91(95%CI:0.87～0.93)and the diagnostic odds ratio was 30.25(95%CI:13.80～66.32).The AUC was 0.91.Conclusion Full Outline of Unresponsiveness can accurately pre dict the early prognosis of critically ill children,has a high predictiv e value,and is suitable for the clinical evaluation of critically ill child ren.PART2 Neurological function evaluation and prognosis analysis of children with consciousness disorderObjective Compare the predictive ability of modified GCS,GCS without verbal component,APCS and FOUR in children with consciousness disorder for selecting a more appropriate tool for children’s neurological assessment,and providing a basis for the prognosis evaluation of children with consciousness disorders.Methods We collected all the scale scores and clinical data of 52children with nontraumatic impairment of consciousness hospitalized in the Children’s Hospital of Chongqing Medical University from June 2020 to January 2021.Analysis of the relationship between scale score and prognosis,and compare the accuracy of each scale in predicting the prognosis of children with disorders of consciousness.Results(1)Among the 52 affected children(29 males and 23females),the male to female ratio was 1.26:1,and the mean age was5.17±To 4.30.The mean hospital length of stay for the 52 patients was19.19±14.83 days.A total of 49 children had head MRI refined before or after admission,and 35(71.4%)were abnormal.A total of 49 children had complete video EEG after admission,of 37(75.5%)were abnormal.(2)Using the PCPC scale for prognostic grading,the rate of poor prognosis was 38.5%,19.2%,18.7%at discharge,3 months after discharge,and 6months after discharge,respectively.(3)There was a negative correlation between the scores on each scale and the PCPC scores at each time after discharge.This suggests that the lower the score on the scale,the greater the likelihood of a poor prognosis.(4)Logistic regression analysis was used to suggest that the modified GCS scale,GCS without verbal component,APCS,and FOUR had better accuracy in predicting prognosis at discharge in children with impaired consciousness(71.2%,73.1%,69.2%,73.1%,respectively.The predictive prognosis of each scale at 3 months after discharge were 82.7%,82.7%,82.7%,78.8%.The predictive prognosis of each scale at 6 months after discharge were both 81.3%and P values>0.05 indicated no statistical significance.(5)The areas under the curve for the modified GCS,the GCS scale without verbal component,the APCS,and FOUR in children with impaired consciousness at hospital discharge were 0.798,0.824,0.759,0.792,the AUC at 3months after discharge was 0.787,0.785,0.762,0.710,and the AUC at 6months after discharge was 0.635,0.631,0.628,0.647.This suggests that each scale has a good accuracy for predicting poor prognosis at discharge and at 3 months after discharge in children with impaired consciousness.Generally good accuracy for predicting poor prognosis at 6 months after discharge,there was no significant difference between the scales.(6)The cut-off values for poor outcome at discharge,after 3 and 6 months were as follows:modified GCS(12,7,8),GCS without verbal component removed(9,6,9),APCS(13,8,7),FOUR(14,12,12),suggesting that children with poor outcome were more likely to have poor prognosis when their score on the equivalent scale fell below each cut-off value.(7)There was a significant difference in prognosis between children treated with video EEG grading at discharge and at 3 months after discharge byχ2 test(x~2=11.844,p=0.019<0.05;x~2=19.736,p=0.001<0.05).Poor prognostic at 3 months after discharge was more likely in children with impaired consciousness with epileptiform discharge and low-output EEG.Conclusion 1.The modified GCS,GCS without verbal component,APCS,and FOUR were negatively associated with prognosis,with lower scores indicating a greater likelihood of poor prognosis.2.The modified GCS,GCS without verbal component,APCS,and FOUR have certain accuracy in predicting the prognosis of children with consciousness disorder,but there is no significant statistical difference.3.When VEEG suggest the presence of epileptiform discharge and low-output EEG.,children with impaired consciousness are more likely to have poor prognosis at 3 months after discharge.