Pediatrics · Infectious Disease · 4 h ago
IEC Criteria May Miss Some Pediatric Encephalitis Cases
A retrospective multicenter analysis of 446 children evaluated for suspected encephalitis in 10 Spanish emergency departments assessed the International Encephalitis Consortium criteria and factors associated with adverse outcomes. Twenty children with a pathogen identified and only one minor criterion had adverse-outcome rates similar to children meeting the criteria.
- Twenty children were classified as subthreshold encephalitis cases.
- Adverse outcomes were similar in IEC and subthreshold groups.
- Abnormal neuroimaging was the strongest outcome predictor.
This secondary analysis of a retrospective multicenter study included children younger than 18 years who underwent cerebrospinal fluid PCR testing for suspected encephalitis at 10 Spanish pediatric emergency departments between 2017 and 2023. Investigators classified 446 children using International Encephalitis Consortium (IEC) criteria and examined predictors of adverse outcomes. They also identified “subthreshold” cases meeting the major criterion and one minor criterion with pathogen confirmation.
Of the 446 children, 118 met IEC criteria: 60 had confirmed, 15 probable and 43 possible encephalitis. Another 20 were classified as subthreshold cases. Adverse outcomes occurred at similar rates in the IEC and subthreshold groups (31.4% and 30.0%, respectively). Abnormal neuroimaging was the strongest independent predictor of adverse outcomes (adjusted odds ratio [aOR], 3.2; 95% CI, 1.6–6.4). Other predictors included focal neurologic deficits (aOR, 2.6), bacterial etiology (aOR, 2.7), seizures (aOR, 2.1) and microbiologic confirmation (aOR, 1.9).
The findings suggest that children with altered mental status, a relevant pathogen and only one minor IEC criterion may be missed by the current classification threshold. The retrospective design and study population—children selected for CSF PCR testing in Spanish emergency departments—limit generalizability; the results do not establish that changing diagnostic criteria improves outcomes.
In practice
In children evaluated for suspected encephalitis, the findings raise the possibility that IEC criteria may not capture every case: 20 children with altered mental status, pathogen confirmation and only one minor criterion were classified as subthreshold, and their adverse-outcome rate was similar to that of children meeting IEC criteria. This retrospective analysis does not show that criteria should be changed or that a different threshold improves outcomes. Its findings may have limited applicability beyond children selected for CSF PCR testing in Spanish emergency departments.
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The Pediatric Infectious Disease Journal: Diagnostic Challenges in Pediatric Infectious Encephalitis ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.