Clinical short term outcome of Guillain-Barre syndrome in children

ABSTRACT

Several factors are useful in predicting the prognosis of Guillain-Barre syndrome [GBS]. The objective of this study was to determine the role of clinical presentation scaling to predict patient's short-term outcome. Forty five patients with the confirmed diagnosis of GBS, according to international diagnostic criteria, were enrolled in this study. All children who were not able to walk unaided [i.e., ordinal disability score=ODS >/= 3] were treated with intravenous immunoglobulin [IVIg] alone or with corticosteroid. The primary outcome measures were the degree of disability at discharge, length of hospital stay, need to intensive care setting and mortality. Male to female ratio was 1.05 1 with mean age of 5.9 years. The most common manifestation was limb weakness [71.1%]. Absent or decreased deep tendon reflexes were seen in 44% and 53.3% patients, respectively. All children experienced some degree of pain, with moderate to severe intensity [pain faces score >/= 3] in 91.2% patients. Cranial nerve involvement was found in 46.7% children, most commonly as bulbar weakness [40%]. Ten [22.2%] patients were admitted in PICU, and ventilation support was needed for 2 [4.4%] of them. Clinical response was regain of unaided walking [ODS patients. After treatment all patients developed significant improvement of functional disability which was assessed by ODS and arm function scores. A higher ODS at presentation was associated significantly with a longer hospital stay [P=0.03] and higher arm function score [P<0.001]. Absent tendon reflexes and cranial nerve involvement were associated with higher functional scores, longer hospital stay and admission in PICU. Also, higher arm function scores were associated significantly with intensive care unit admission [P=0.01]. These results indicate that the ODS and arm function scores can be applied as prognostic factor for clinical short-term outcome among GBS patients