Person: Tasker, Robert
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Publication Seizures in 204 Comatose Children: Incidence and Outcome
(Springer-Verlag, 2012) Kirkham, Fenella J.; Wade, Angela M.; McElduff, Fiona; Boyd, Stewart G.; Tasker, Robert; Edwards, Melinda; Neville, Brian G. R.; Peshu, Norbert; Newton, Charles R. J. C.Purpose: Seizures are common in comatose children, but may be clinically subtle or only manifest on continuous electroencephalographic monitoring (cEEG); any association with outcome remains uncertain. Methods: cEEG (one to three channels) was performed for a median 42 h (range 2–630 h) in 204 unventilated and ventilated children aged (\leq) 15 years (18 neonates, 61 infants) in coma with different aetiologies. Outcome at 1 month was independently determined and dichotomized for survivors into favourable (normal or moderate neurological handicap) and unfavourable (severe handicap or vegetative state). Results: Of the 204 patients, 110 had clinical seizures (CS) before cEEG commenced. During cEEG, 74 patients (36 %, 95 % confidence interval, 95 % CI, 32–41 %) had electroencephalographic seizures (ES), the majority without clinical accompaniment (non-convulsive seizures, NCS). CS occurred before NCS in 69 of the 204 patients; 5 ventilated with NCS had no CS observed. Death (93/204; 46 %) was independently predicted by admission Paediatric Index of Mortality (PIM; adjusted odds ratio, aOR, 1.027, 95 % CI 1.012–1.042; p < 0.0005), Adelaide coma score (aOR 0.813, 95 % CI 0.700–0.943; p = 0.006), and EEG grade on admission (excess slow with >3 % fast, aOR 5.43, 95 % CI 1.90–15.6; excess slow with <3 % fast, aOR 8.71, 95 % CI 2.58–29.4; low amplitude, 10th centile <9 (\mu)V, aOR 3.78, 95 % CI 1.23–11.7; and burst suppression, aOR 10.68, 95 % CI 2.31–49.4) compared with normal cEEG, as well as absence of CS at any time (aOR 2.38, 95 % CI 1.18–4.81). Unfavourable outcome (29/111 survivors; 26 %) was independently predicted by the presence of ES (aOR 15.4, 95 % CI 4.7–49.7) and PIM (aOR 1.036, 95 % CI 1.013–1.059). Conclusion: Seizures are common in comatose children, and are associated with an unfavourable outcome in survivors. cEEG allows the detection of subtle CS and NCS and is a prognostic tool.
Publication Should involvement in a trial be discussed at a bereavement follow up visit? Views of clinicians and bereaved parents from the bracelet study (bereavement and randomised controlled trials)
(BioMed Central, 2013) Snowdon, Claire; Brocklehurst, Peter; Tasker, Robert; Platt, Martin Ward; Elbourne, DianaPublication Methodological considerations for neonatal trials involving multiples: lessons from the bracelet study (bereavement and randomised controlled trials)
(BioMed Central, 2013) Snowdon, Claire; Brocklehurst, Peter; Tasker, Robert; Platt, Martin Ward; Elbourne, DianaPublication Feeding back the results of trials to the families of participants who have died: methodological considerations from the bracelet study (bereavement and randomised controlled trials)
(BioMed Central, 2013) Snowdon, Claire; Brocklehurst, Peter; Tasker, Robert; Platt, Martin Ward; Elbourne, DianaPublication “You have to keep your nerve on a DMC.” Challenges for data monitoring committees in neonatal intensive care trials: qualitative accounts from the bracelet study
(BioMed Central, 2015) Snowdon, Claire; Elbourne, Diana; Brocklehurst, Peter; Platt, Martin Ward; Tasker, Robert