Bülent KARAPINAR, Ayşe ANIK, Ömer KİTİŞ, Hasan TEKGÜL, Gül AKTAN, Sanem YILMAZ, Sarenur GÖKBEN

Pediatrik non-travmatik koma prognozunu öngörmede klinik, elektroensefalografik ve nöroradyolojik parametrelerin rolü

Amaç: Pediatrik non-travmatik komada (NTK) erken dönem prognozun; klinik, elektroensefalografik ve nöroradyolojik faktörlerle ilişkisini araştırmak amaçlandı. Gereç ve Yöntem: Bu retrospektif kesitsel çalışmaya, akut ensefalopati ve NTK tanılı 77 çocuk hasta (ortalama yaş 70.5±68.7 ay, %55.8 erkek) alınmıştır. Hastaların demografik özellikleri (yaş, cinsiyet, komanın sebebi), prognozlarını belirleyen faktörler [Glasgow koma skoru (GKS)], pupil ışık refleksi, EEG ve kraniyal MR sonuçları) ve erken nörolojik sonuçları (yoğun bakım dönemi ve taburculuk sonrası ilk 3 ay) kaydedildi. Bulgular: Nontravmatik koma etiyolojisinde en sık nedenlerin hipoksik iskemik ensefalopati (HİE) ve santral sinir sistemi enfeksiyonu olduğu saptandı. İyi ve kötü nörolojik sonuçlar sırasıyla %57 ve % 43 olarak bulundu. Işık refleksinin olmaması (OR 3.09, 95% CI: 2.17 to 4.40, p<0.001), GKS ≤5 (OR 7.85, 95% CI: 2.77 to 22.37, p<0.001), EEG’de kötü prognostikpaternizlenmesi (OR 13.76, 95% CI: 1.62 to116.54, p=0.004) ve kraniyal MR’da lezyon varlığı (OR 4.04, 95% CI: 1.15 to 14.19, p=0.029) kötü prognostik bulgu olarak bulundu. Sonuç: Pediatrik NTK’da klinik, EEG ve kraniyal MR sonuçlarının kombine değerlendirilmesi hastanın nörolojik prognozunu değerlendirmede daha doğru sonuçlar verecektir.

Anahtar Kelimeler:

koma, nörogörüntüleme, prognoz

The prognostic role of clinical, electroencephalographic and neuro-radiological parameters in predicting outcome in pediatric non-traumatic coma

Objective: To investigate early outcome of non-traumatic coma (NTC) in pediatric critical care in relation to prognostic role of clinical, electroencephalographic and neuro-radiological factors. Methods: A total of 77 children (mean(SD) age: 70.5±68.7 months, 55.8% were boys) with acute encephalopathy and NTC were included in this retrospective cross-sectional study. Data on patient demographics (age, gender, etiology of NTC) and four prognostic factors [Glasgow coma scores (GCS), pupillary light reflex (PLR), EEG and cranial MRI findings] and neurological outcome (ICU period and post-discharge 3rd month) were recorded in each patient. Results: Hypoxic-ischemic encephalopathy (35.1%) and CNS infection (22.1%) were the most common etiologies in the cohort. Favorable and unfavorable neurological outcome were noted in 57% and 43% of patients, respectively. Lack of PLR (OR 3.09, 95% CI: 2.17 to 4.40, p<0.001), GCS ≤5 (OR 7.85, 95% CI: 2.77 to 22.37, p<0.001), poor prognostic pattern in EEG (OR 13.76, 95% CI: 1.62 to 116.54, p=0.004) and presence of MRI lesions (OR 4.04, 95% CI: 1.15 to 14.19, p=0.029) were significant determinants of unfavorable neurological outcome. Conclusion: In conclusion, our findings emphasize that combined used of clinical, EEG and MRG patterns might provide more accurate estimation of neurological outcome in pediatric NTC.

Keywords:

Non-traumatic coma, neuroimaging, prognostic factors,

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