Assessing disability after encephalitis: development of a new outcome score in India and Malaysia

Objective To develop a simple tool for assessing the severity of disability

resulting from Japanese encephalitis and whether, as a result, a child is likely

to be dependent.

Methods A new outcome score based on a 15-item questionnaire was

developed after a literature review, examination of current assessment tools,

discussion with experts and a pilot study. The score was used to evaluate 100

children in Malaysia (56 Japanese encephalitis patients and 44 controls) and

95 in India (36 Japanese encephalitis patients, 41 patients with encephalitis of

unknown etiology and 18 controls). Inter- and intra-observer variability in the

outcome score was determined and the score was compared with full clinical

assessment.

Findings There was good inter-observer agreement on using the new

score to identify likely dependency (κ = 0.942 for Malaysian children;

κ = 0.786 for Indian children) and good intra-observer agreement (κ = 1.000

and 0.902, respectively). In addition, agreement between the new score and

clinical assessment was also good (κ = 0.906 and 0.762, respectively). The

sensitivity and specificity of the new score for identifying children likely to be

dependent were 100% and 98.4% in Malaysia and 100% and 93.8% in India.

Publication: Bulletin of the World Health Organization; Type: Research

Article DOI: 10.2471/BLT.09.071357

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Positive and negative predictive values were 84.2% and 100% in Malaysia

and 65.6% and 100% in India.

Conclusion The new tool for assessing disability in children after

Japanese encephalitis was simple to use and scores correlated well with

clinical assessment.