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Abnormal intra-aural pressure waves associated with death in African children with acute nontraumatic coma

Abnormal intra-aural pressure waves associated with death in African children with acute nontraumatic coma
Abnormal intra-aural pressure waves associated with death in African children with acute nontraumatic coma

BACKGROUND: We explored the relationship between tympanic membrane displacement (TMD) measurements, a tool to monitor intracranial pressure noninvasively, and clinical features and death in children with acute coma in Kilifi, Kenya.

METHODS: Between November 2007 and September 2009, we made serial TMD measurements and clinical observations on children with acute coma (Blantyre coma score (BCS) ≤ 2) on the pediatric high dependency unit of Kilifi District Hospital, and on well children presenting to the hospital's outpatient department for routine follow-up. We examined middle ear function using tympanometry and measured cardiac pulse (CPA) and respiratory pulse pressure amplitudes (RPA) using the TMD analyzer.

RESULTS: We recruited 75 children (32 (43%) females; median age 3.3 (IQR: 2.0, 4.3) years). Twenty-one (28%) children died. Higher TMD measurements predicted death. Adjusting for diagnosis, every 50 nl rise in both semirecumbent and recumbent CPA was associated with increased odds of death associated with intracranial herniation (OR: 1.61, 95% confidence interval (CI): 1.07, 2.41; P = 0.02 and OR: 1.35, 95% CI: 1.10, 1.66; P ≤ 0.01 respectively).

CONCLUSION: Raised TMD pulse pressure measurements are associated with death and may be useful in detecting and monitoring risk of intracranial herniation and intracranial pressure in childhood coma.

Acoustic Impedance Tests, Blood Pressure, Brain Diseases, Child, Child, Preschool, Coma, Female, Humans, Infant, Intracranial Pressure, Kenya, Malaria, Cerebral, Male, Monitoring, Physiologic, Observer Variation, Time Factors, Tympanic Membrane, Journal Article, Research Support, Non-U.S. Gov't
0031-3998
38-43
Gwer, Samson
6418bf02-004a-489f-b8b6-6fee801ec692
Kazungu, Michael
450a3bb5-3c19-45bf-a143-6af204781388
Chengo, Eddie
1099a0b0-15a6-449c-80c6-93bfe0ee0917
Ohuma, Eric O.
dcb8336d-f211-42d6-8a41-a7eb43b70763
Idro, Richard
4b04dd1a-6f52-4b7b-bdea-31fb066ff558
Birch, Tony
755f2236-4c0c-49b5-9884-de4021acd42d
Marchbanks, Robert
1ebe90b6-cb8a-4f9e-9585-4e264a951d7f
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Newton, Charles R.
ea661613-9a2d-4e14-8d04-2d1c0804a321
Gwer, Samson
6418bf02-004a-489f-b8b6-6fee801ec692
Kazungu, Michael
450a3bb5-3c19-45bf-a143-6af204781388
Chengo, Eddie
1099a0b0-15a6-449c-80c6-93bfe0ee0917
Ohuma, Eric O.
dcb8336d-f211-42d6-8a41-a7eb43b70763
Idro, Richard
4b04dd1a-6f52-4b7b-bdea-31fb066ff558
Birch, Tony
755f2236-4c0c-49b5-9884-de4021acd42d
Marchbanks, Robert
1ebe90b6-cb8a-4f9e-9585-4e264a951d7f
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Newton, Charles R.
ea661613-9a2d-4e14-8d04-2d1c0804a321

Gwer, Samson, Kazungu, Michael, Chengo, Eddie, Ohuma, Eric O., Idro, Richard, Birch, Tony, Marchbanks, Robert, Kirkham, Fenella J. and Newton, Charles R. (2015) Abnormal intra-aural pressure waves associated with death in African children with acute nontraumatic coma. Pediatric Research, 78 (1), 38-43. (doi:10.1038/pr.2015.57).

Record type: Article

Abstract

BACKGROUND: We explored the relationship between tympanic membrane displacement (TMD) measurements, a tool to monitor intracranial pressure noninvasively, and clinical features and death in children with acute coma in Kilifi, Kenya.

METHODS: Between November 2007 and September 2009, we made serial TMD measurements and clinical observations on children with acute coma (Blantyre coma score (BCS) ≤ 2) on the pediatric high dependency unit of Kilifi District Hospital, and on well children presenting to the hospital's outpatient department for routine follow-up. We examined middle ear function using tympanometry and measured cardiac pulse (CPA) and respiratory pulse pressure amplitudes (RPA) using the TMD analyzer.

RESULTS: We recruited 75 children (32 (43%) females; median age 3.3 (IQR: 2.0, 4.3) years). Twenty-one (28%) children died. Higher TMD measurements predicted death. Adjusting for diagnosis, every 50 nl rise in both semirecumbent and recumbent CPA was associated with increased odds of death associated with intracranial herniation (OR: 1.61, 95% confidence interval (CI): 1.07, 2.41; P = 0.02 and OR: 1.35, 95% CI: 1.10, 1.66; P ≤ 0.01 respectively).

CONCLUSION: Raised TMD pulse pressure measurements are associated with death and may be useful in detecting and monitoring risk of intracranial herniation and intracranial pressure in childhood coma.

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Accepted/In Press date: 12 December 2014
e-pub ahead of print date: 19 March 2015
Published date: July 2015
Keywords: Acoustic Impedance Tests, Blood Pressure, Brain Diseases, Child, Child, Preschool, Coma, Female, Humans, Infant, Intracranial Pressure, Kenya, Malaria, Cerebral, Male, Monitoring, Physiologic, Observer Variation, Time Factors, Tympanic Membrane, Journal Article, Research Support, Non-U.S. Gov't

Identifiers

Local EPrints ID: 420601
URI: https://eprints.soton.ac.uk/id/eprint/420601
ISSN: 0031-3998
PURE UUID: be197536-853b-4bdb-a324-d35cf02b7ffe
ORCID for Tony Birch: ORCID iD orcid.org/0000-0002-2328-702X

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Date deposited: 10 May 2018 16:31
Last modified: 14 Mar 2019 01:22

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Contributors

Author: Samson Gwer
Author: Michael Kazungu
Author: Eddie Chengo
Author: Eric O. Ohuma
Author: Richard Idro
Author: Tony Birch ORCID iD
Author: Robert Marchbanks
Author: Fenella J. Kirkham
Author: Charles R. Newton

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