Sharshar et al identified risk factors the predicted the need for mechanical ventilation in a patient with Guillain-Barre syndrome. These can help identify those patients who may require closer monitoring and early initiation of ventilation. The authors are from Raymond Poincare (Garches) and Saint Louis (Paris) Teaching Hospitals in France.
Parameters for first score:
(1) time from onset to hospital admission
(2) ability to cough
(3) ability to stand
(4) ability to lift elbows
(5) ability to lift head from bed
(6) liver enzyme concentrations
|
Parameter |
Finding |
Points |
|
time from onset to hospital admission |
> 7 days |
0 |
|
|
<= 7 days |
1 |
|
able to cough |
yes |
0 |
|
|
no |
1 |
|
able to stand |
yes |
0 |
|
|
no |
1 |
|
able to lift elbow above bed |
yes |
0 |
|
|
no |
1 |
|
able to lift head from bed |
yes |
0 |
|
|
no |
1 |
|
serum liver enzyme concentrations |
normal or decreased |
0 |
|
|
elevated |
1 |
|
Parameter |
Odds Ratio |
95% CI |
p value (ran-domized) |
|
time to admission <- 7 days |
2.5 |
1.68-3.77 |
0.0001 |
|
inability to stand |
2.5 |
1.40-3.30 |
0.0015 |
|
inability to lift elbow |
3.0 |
1.80-4.97 |
0.0021 |
|
inability to lift head |
4.3 |
2.70-6.66 |
0.0001 |
|
inability to cough |
9.1 |
4.00-20.00 |
0.0001 |
|
liver enzymes increased |
2.1 |
1.38-3.17 |
0.0038 |
from Table 3, page 281
total score for first model =
= SUM(points for all 6 parameters)
Parameters for second model:
(1) time from onset to hospital admission
(2) ability to lift head from bed
(3) vital capacity
|
Parameter |
Finding |
Points |
|
time from onset to hospital admission |
> 7 days |
0 |
|
|
<= 7 days |
1 |
|
able to lift head from bed |
yes |
0 |
|
|
no |
1 |
|
vital capacity as percent of predicted |
>= 60% |
0 |
|
|
< 60% |
1 |
|
Parameter |
Odds Ratio |
95% CI |
p value (ran-domized) |
|
time to admission <- 7 days |
5.0 |
1.42-5.68 |
0.003 |
|
inability to lift head |
5.0 |
1.92-12.50 |
0.0011 |
|
vital capacity |
2.89 |
2.43-10.00 |
0.0001 |
from Table 4, page 281
total score for second model =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score for first model: 6
• maximum score for second model: 3
• A patient with one or more risk factors should be monitored in the intensive care unit (ICU).
|
Total Score First Model |
Percent Requiring Mechanical Ventilation |
|
0 |
8% |
|
1 |
18% |
|
2 |
35% |
|
3 |
62% |
|
4 |
85% |
|
5 |
98% |
|
6 |
100% |
If all 3 risk factors from the second model are present, then 85% will require mechanical ventilation.
Specialty: Neurology, Immunology/Rheumatology, Infectious Diseases
