The inter-rater reliability and prognostic value of coma scales in Nepali children with acute encephalitis syndrome

Figures & data

Table 1. Coma scales used in the study.

Blantyre coma scale		Glasgow coma scale	Adelaide paediatric coma scale			AVPU
Eye response
Directed eye movement	1	Spontaneous	4	Spontaneous	4	Alert	4
Not directed	0	To speech	3	To speech	3	Voice	3
		To pain	2	To pain	2	Pain	2
		None	1	None	1	Unresponsive	1
Best verbal response
Appropriate cry	2	Oriented	5	Oriented	5
Inappropriate cry/moan	1	Confused	4	Words	4
No cry	0	Inappropriate words	3	Vocal sounds	3
		Incomprehensible sounds	2	Cries	2
		None	1	None	1
Best motor response
Localises pain	2	Obeys	6	Obeys commands	5
Withdraws from pain	1	Localises	5	Localises pain	4
No response	0	Withdraws	4	Flexion to pain	3
		Abnormal flexion	3	Extension to pain	2
		Extensor response	2	None	1
		None	1
Total 0–5		Total 3–15		Total 3–14		Total 1–4

Figure 1. Study flowchart.

Figure 2. Bland–Altman plot measuring agreement between total Glasgow coma score and outcome (Liverpool outcome score). The plot displays mean (X axis) and difference (Y axis) in the total LOS (scored on discharge) and total GCS scores (scored on admission) in child AES patients (n = 50). Dotted lines demarcate the limits of agreement (±2 standard deviations from the mean difference). Forty-three children had scores for both the LOS and GCS within the limits of agreement. Seven children plotted below the lower limit of agreement.

Table 2. Physiological parameters, GCS score and Liverpool outcome score in paediatric AES patients (n = 22).

	Alive, n = 18 Median (range) [No. of patients]	Dead, n = 4 Median (range) [No. of patients]	p–value*
Days since onset	5 (3–13) [11]	4 (3–14)	0.72
Admission GCS	12 (4–15)	4 (3–10)	0.02
LOS	69 (46–75)	1 (1)	0.00
Age (years)	7.0 (1–13)	11.5 (9–14)	0.06
Systolic blood pressure	110 (80–125) [15]	86 (80–90) [3]	0.04
Respiratory rate	35 (20–68)	17 (12–40)	0.06
Heart rate	108 (80–120)	111 (65–138)	0.67
Temperature	31.2 (29.2–37.2)	38.9 (36.7–39.4) [3]	0.05

Notes: *p-values in bold are statistically significant. Significance of difference between groups measured by t-test or Mann–Whitney U-test. GCS, GCS (score 3–15); LOS, Liverpool Outcome Score (1 [died] – 75 [no impairment]).

Table 3. Multivariable logistic regression model with variable selection via backward selection.

Variable	Univariable p-value*	Univariable OR (95% CI)	Multivariable p-value*	Multivariable OR (95% CI)
Admission GCS	0.01	0.67 (0.38–0.93)	0.06	0.68 (0.34–1.02)
Heart rate	0.64	0.99 (0.93–1.05)	N/A	N/A
Respiratory rate	0.03	0.87 (0.71–0.99)	N/A	N/A
Blood pressure	0.03	0.82 (0.58–0.98)	0.02	0.78 (0.46–0.98)

Notes: *p-values in bold are statistically significant. OR, odds ratio; CI, confidence interval; N/A, dropped from multivariable model during backward selection.