Epidemiology of Children With Acute Neurologic Dysfunction in Resource-Constrained Settings

Tuesday, March 24, 2026

10:00 AM - 11:00 AM Central Time

Location: Connections Central - RST 06

Paula Caporal, MD, MPH (she/her/hers)

Johns Hopkins University - Bloomberg School of Public Health, District of Columbia

Disclosure(s): No relevant financial relationship(s) to disclose.
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Ericka Fink, MD, FCCM

UPMC Children's Hospital of Pittsburgh, Pennsylvania

Disclosure information not submitted.
Teresa B. Kortz, MD (she/her/hers)

University of California San Francicso, California

Disclosure information not submitted.
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Adrian Holloway, MD

Associate Professor
University of Maryland Children's Hospital, Maryland

Disclosure information not submitted.
Kenneth Remy, MD, MSc, MSCI, FCCM

Case Western Reserve University/University Hospitals Cleveland Medical Center, Ohio

Disclosure(s): No relevant financial relationship(s) to disclose.
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Adnan Bhutta, MD, FCCM (he/him/his)

Riley Hospital for Children Indiana University, Indiana

Disclosure information not submitted.
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Fangqian Ouyang, MS

Biostatistician II
Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health, Indiana University School of Medicine,

Disclosure information not submitted.
MW

Matthew Wiens, PharmD, PhD

Assistant Professor
Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia

Disclosure information not submitted.
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Madiha Raees, MD

Assistant Professor of Anesthesiology, Critical Care, and Pediatrics
Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania

Disclosure information not submitted.

Introduction: Acute neurologic dysfunction (AND) is a key contributor to pediatric critical illness globally and is associated with increased resource utilization and mortality. However, its epidemiology and outcomes remain poorly characterized in resource-constrained settings (RCS). We hypothesized that children in RCS presenting with AND would have increased resource utilization and higher mortality than those without AND on presentation.

Methods: We conducted a secondary analysis of Global PARITY, a prospective, observational, point prevalence study in 46 RCS hospitals across 19 countries. On four designated days from July 20, 2021 to July 12, 2022, all children aged 29 days to 14 years presenting with an acute illness or injury were enrolled and followed for 31 days or until discharge. AND was defined as altered mental status (based on Alert, Verbal, Painful, and Unresponsive, Glasgow Coma Scale, or Blantyre coma scale scores) or seizures on presentation. We report epidemiology, resource utilization, and discharge outcomes of children with and without neurologic dysfunction.

Results: Among 7,538 children (mean age 5 years), 175 (2.3%) presented with AND. At presentation, tachypnea (42.9% vs. 11.6%), hypoxia (24.6% vs. 5.7%), and seizures (38.3% vs. 4.6%) occurred more frequently in children with AND. Children with AND had longer hospitalizations (median LOS: 2.2 days [IQR 0.3–6.2] vs. 0.1 days [IQR 0.1–1.1]), more frequent use of invasive mechanical ventilation (4.6% vs. 0.5%), and markedly higher unadjusted mortality (19.4% vs. 0.5%). AND patients were also less often discharged home (68.0% vs. 91.9%).

Conclusions: In this large, multicenter pediatric cohort from RCS, acute neurologic dysfunction was associated with greater resource utilization and a nearly 40-fold higher unadjusted mortality rate. These findings highlight an urgent need for strategies to enhance early recognition and management of neurologic dysfunction in resource-constrained settings. Development and implementation of context-appropriate clinical guidelines may improve care and outcomes for this vulnerable population. Future directions of this work will include identification of key predictors of mortality in this high-risk subpopulation.