PP05.16 – 2675: Observational analysis of profiles of children with acute encephalopathy undergoing MRI brain

Abstract

Objective To ascertain factors identifying comatose children presenting to the emergency department (ED) likely to benefit from MRI brain and to determine the impact of MRI on management. Methods This was a prospective, observational study in a developing country, on children, 2 months to 12 years old, presenting to the ED with acute encephalopathy and undergoing MRI brain. Decision regarding MRI was taken by the treating unit. MRI was classified as contributory or non-contributory by the treating unit based on information obtained from MRI. Subcategories within contributory group were a) Diagnostic and/or therapeutic: MRI changed ongoing management and had a direct impact on prognosis. b) Suggestive: MRI suggested a diagnosis that changed further work up; this secondarily altered management or prognosis. C) Additive and/or prognostic: MRI did not change management but aided in diagnosis and/or contributed to understanding the disease process and prognosis. Results 12893 children were admitted during the study; 496 had acute encephalopathy and 100 (mean age – 44.6 months) were finally evaluated. Viral meningoencephalitis (45) was the commonest diagnosis. Seventy seven had contributory MRI, out of which 41 had a diagnostic/therapeutic MRI, 10 had suggestive and 26 had an additive MRI. CT scan was done in 82 children before MRI; it was normal in 36 children and abnormal in 46. Only in 18 out of 82 children who underwent both CT and MRI, did MRI not reveal additional findings. Those with abnormal CT were significantly more likely to have a contributory MRI (65.6% vs 22.2%, P=0.001). Conclusion There were no other major clinical or investigational clues to identify children who would benefit from MRI. MRI contributed to patient care in over 3/4th of children and had an impact on treatment in half of them. Children with abnormal CT were the most likely to benefit from MRI.