Objective:

To evaluate the impact of a pediatric autoimmune encephalitis (AE) pathway on time to treatment initiation

Background:

Delayed AE treatment can cause long-term cognitive and functional impairments. Diagnostic uncertainty and workup variability often prolong treatment initiation. We created and implemented an AE pathway at our institution to standardize management and expedite treatment to improve patient outcomes.

Design/Methods:

We identified cases of pediatric patients from 2016 to present who received steroids and had at least one note mentioning “autoimmune encephalitis” using ATLAS, a system to analyze our hospital system electronic records in aggregate. Through manual chart review of these cases, we generated a final cohort of pediatric AE cases using these inclusion criteria: age <21 years at presentation and treated inpatient at our hospital with intravenous steroids for suspected AE. We compared management of these cases pre- versus post-AE pathway implementation. Population normality was assessed with Shapiro-Wilk tests, and population medians were compared using two-tailed Mann-Whitney U tests.

Results:

The final cohort included 73 patients (pre-pathway:66; post-pathway:7). Age at presentation (Mean+SD): 11.9+6.2 years; Sex: 52% male, 48% female; Ethnicity: 51% Hispanic/Latino, 41% Not Hispanic/Latino, 8% Unknown/Declined. Median time to steroid initiation was significantly reduced after pathway implementation (4.27 days pre-pathway vs. 2.15 days post-pathway, p=0.0442). There was a trend to reduction in median time to MRI (2.04 days pre vs 0.83 days post, p=0.1894) and EEG (1.87 days pre vs 0.96 days post, p=0.3091), but not in median time to LP (2.35 days pre vs 2.52 days post, p=0.9748).

Conclusions:

Time to initiation of steroid therapy was significantly reduced after implementation of a pediatric AE clinical pathway at our institution. Further data collection and outlier assessment can improve understanding of the pathway’s effect on time to workup measures. The study findings support the effectiveness of a standardized protocol to improve management of AE patients.