PP08.11 – 2891: Predictors of intensive care requirement in children with Guillain-Barré syndrome: A retrospective study

Abstract

Objective Pre-emptive transfer to a tertiary centre with onsite paediatric intensive care unit (PICU) support is preferable to transfer of the decompensated child in Guillain-Barre syndrome (GBS). Our aim was to identify presenting clinical, laboratory and neurophysiological features associated with requirement for PICU in children with GBS. Methods Retrospective review of children attending our tertiary centre over an 11 year period. Inclusion criteria Documented nerve conduction study and examination by a paediatric neurologist during the acute illness with features meeting consensus case definitions for GBS or Fisher syndrome (FS). Data were collected on symptoms, examination findings, laboratory and neurophysiological investigations, PICU admission and illness course. Results 52 children met case definition for GBS; one child met case definition for FS. Median age was 4 years (range 0.6–16); 55% were female. 13 children (25%) required PICU admission and 9 (17%) required ventilation for respiratory failure for a median 7 days (range 3–22). Significant predictors of requirement for PICU were bulbar involvement (odds ratio [OR] 55.0, 95% confidence interval [CI] 3.0–996), respiratory involvement (OR 25.9, 95% CI 4.7–144), autonomic dysfunction (OR 4.8, 95% CI 1.3–18.1), hypertension (OR 11.9, 95% CI 1.9–72.4), bradycardia (OR 27.0, 95% CI 1.3–564) and loss of antigravity power in ≥1 muscle group (OR 10.6, 95% CI 2.5–44.7). Mean erythrocyte sedimentation rate was 97 mm/hr in the PICU group and 34 mm/hr in the non-PICU group (p=0.004). Other variables including CSF protein, neurophysiological parameters and rate of progression did not differ significantly between groups. Conclusion Bulbar involvement, respiratory involvement, dysautonomia, profound weakness and extreme elevation in ESR are significantly associated with requirement for PICU in GBS. Identification of these features at presentation should prompt early consideration for transfer to a tertiary centre with onsite PICU support. Slow progression of weakness is a false reassuring feature in predicting eventual requirement for PICU.