Eeg Is A Valid Diagnostic Biomarker In Pediatric Febrile Coma In Africa

Introduction In malaria endemic areas, asymptomatic parasitemia is common. As cerebral malaria (CM) is the most common cause of febrile coma in endemic areas, when presenting to health care facilities, a malaria test is usually the first evaluation performed. Children with non-malarial coma etiologies (viruses, bacteria) with asymptomatic parasitemia may be mistakenly diagnosed as having CM. In this common clinical situation, there are few diagnostic biomarkers that, in an African child with febrile coma, can determine whether coma is of malarial or non-malarial etiology. Methods Using both qualitative and quantitative techniques, we analyzed electroencephalogram (EEG) studies from children with proven non-malarial etiologies of coma (n= 88) and compared them to EEGs from children with CM (n=201). Results Using qualitative EEG analysis methods, children with CM were more likely to have higher voltages (average and maximum), preserved variability, and a suppressed or attenuated background, compared to children with non-malarial febrile coma (all p<0.001). Using quantitative EEG analysis methods, children with CM were more likely to have higher power (total, alpha, theta, delta), theta-alpha/delta ratios, and peak envelope, compared to children with non-malarial coma (all p< 0.001). Predictive modeling using both qualitative and quantitative interpretation methods showed clear separation of probability density curves between malarial and non-malarial groups. Conclusions EEG is a valid diagnostic biomarker in febrile coma in African children, able to differentiate coma of malarial and non-malarial etiology. Disclosure Supported by NIH 1R03NS124536