Risk factors and outcomes in paediatric acute febrile encephalopathy: a cross-sectional study from a tertiary care centre in North India

Background: Acute Febrile Encephalopathy (AFE) is a frequent cause of emergency admissions in children, particularly in India, where it poses a significant public health challenge due to high morbidity and mortality rates. This study aims to bridge some of these gaps by analyzing the clinical features, incidence, and mortality-associated risk factors in pediatric AFE cases in a hospital-based setting in North India. Methods: This hospital-based cross-sectional study was conducted over one year (January 2020 to December 2020) in the Pediatric Intensive Care Unit (PICU) of Indira Gandhi Medical College and Hospital, Shimla. The study included all pediatric patients aged 1 to 18 years admitted to the PICU with clinical evidence of AFE, fulfilling specific inclusion criteria. Data were collected on patient demographics, clinical presentation, and relevant investigations. Key risk factors, such as shock, need for ventilatory support, Glasgow Coma Scale (GCS) scores, and Multiple Organ Dysfunction Syndrome (MODS), were assessed for their association with mortality. Results: Out of 2,832 pediatric admissions, 550 children were admitted to the PICU, and 69 met the inclusion criteria for AFE, resulting in an AFE incidence of 12.5% in the PICU and 2.4% of total hospital admissions. The study observed a slight male preponderance (56.5% male, 43.4% female) and found that the most affected age group was 10 to 18 years (43%). The overall mortality rate among AFE patients was 26%, contributing to 13.7% of the total PICU mortality. Significant risk factors associated with mortality included late hospital presentation (mortality rate of 50% in patients presenting after 7 days of symptom onset), ventilatory support (69.6% mortality), shock (44.4% mortality), MODS (47.6% mortality), Disseminated Intravascular Coagulation (DIC) (100% mortality), and GCS <8 (56.5% mortality). Conclusion: AFE remains a significant contributor to pediatric morbidity and mortality, particularly in resource-limited settings. The study identifies key risk factors such as shock, ventilatory support, DIC, MODS, and low GCS, which are strongly associated with increased mortality. Early recognition and timely intervention are critical to improving outcomes.