Abstract Details

Title Middle Ear Function and Mortality in African Children with Acute Non-Traumatic Coma

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P01 - (-)

Poster/Presentation
Number 026

Objective

Background Childhood coma is a common presentation of severe illness in Africa. Raised Intracranial Pressure (ICP) is one of the risk factors for poor outcome but tools for monitoring ICP are invasive and out of reach for most health facilities. We have been investigating the utility of a non-invasive tool for monitoring ICP, the tympanic membrane displacement (TMD) analyser, in children with acute non-traumatic coma. In using this technique, normal middle ear function, as assessed through tympanometry, is important for valid measurements.

Design/Methods We recruited children presenting with acute non-traumatic coma (not able to localize painful stimuli) to the high dependency unit of Kilifi District Hospital in the rural Coast of Kenya. We excluded children with neuro-developmental delay. We performed tympanometry on the right ear prior to TMD analyser measurements. All children were managed according to standard WHO guidelines.

Results We recruited 72 children of median age 2 [inter-quartile range (IQR) 2.0,4.3] years; 31(43%) were female. Thirty eight (53%) had cerebral malaria, 8 (11%) acute bacterial meningitis, 4 6%) sepsis, and 22(30%) encephalopathy of unknown aetiology. Twenty-one (28%) children died. Tympanometry was normal in only 25 (35%) children. Adjusting for diagnosis and clinical features of raised ICP, children with abnormal tympanometry had greater odds of dying compared to those with normal tympanometry [Odds ratio (OR) 17.0 (95% CI 1.9,152.4); P=0.01]. Children who died had a lower compliance (0.29[IQR 0.09,0.33] ml)compared to those who survived(0.48 [IQR 0.29, 0.70] ml) (P<0.01).

Conclusions Abnormal tympanometry appears to be significantly associated with death in children with acute non-traumatic coma. This finding needs to be explored further through a prospective study that incorporates imaging and intensive physiological monitoring.

Authors/Disclosures
Samson Gwer PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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