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Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery
1Department of Paediatrics, Imperial College School of Medicine, St Mary's Hospital, Norfolk Place, London W2 1PG, UK.
Background And Aims:
The case fatality rate from meningococcal disease (MD) has remained relatively unchanged in the post antibiotic era, with 20-50% of patients who develop shock still dying. In 1992 a new paediatric intensive care unit (PICU) specialising in MD was opened. Educational information was disseminated to local hospitals, and a specialist transport service was established which delivered mobile intensive care. The influence of these changes on mortality of children with MD was investigated.
Methods:
A total of 331 consecutive children with meningococcal disease admitted to the PICU between 1992 and 1997 were studied. Severity of the disease on admission was assessed using the paediatric risk of mortality (PRISM) score. Logistic regression analysis was used to correct for clinical severity, age, and sex; death was the outcome, and year of admission, a temporal trend variable, was the primary exposure.
Results:
The case fatality rate fell year on year (from 23% in 1992/93 to 2% in 1997) despite disease severity remaining largely unchanged. After adjustment for age, sex, and disease severity, the overall estimate for improvement in the odds of death was 59% per year (odds ratio for the yearly trend 0.41).
Conclusions:
A significant improvement in outcome for children admitted with MD to a PICU has occurred in association with improvements in initial management of patients with MD at referring hospitals, use of a mobile intensive care service, and centralisation of care in a specialist unit.
Insights
Improved management and specialized care significantly reduced childhood meningococcal disease (MD) mortality. A dedicated pediatric intensive care unit (PICU) and mobile intensive care services led to a dramatic decrease in deaths from this serious infection.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Meningococcal disease (MD) has a high case fatality rate, especially in children with shock.
- The post-antibiotic era has seen little improvement in MD mortality rates.
- A specialized pediatric intensive care unit (PICU) for MD was established in 1992.
Purpose of the Study:
- To investigate the impact of a new PICU and associated services on childhood MD mortality.
- To assess trends in MD case fatality rates following service centralization and improved initial management.
Main Methods:
- A cohort of 331 children with MD admitted to the PICU from 1992 to 1997 was analyzed.
- Disease severity was assessed using the Pediatric Risk of Mortality (PRISM) score.
- Logistic regression was used to adjust for severity, age, sex, and identify temporal trends in mortality.
Main Results:
- The case fatality rate for childhood MD decreased significantly from 23% in 1992/93 to 2% in 1997.
- Despite consistent disease severity, the odds of death improved by 59% annually (OR 0.41).
Conclusions:
- Centralization of care in a specialist PICU improved outcomes for children with MD.
- Enhanced initial management at referring hospitals and mobile intensive care services contributed to reduced mortality.
- These integrated improvements demonstrate a successful strategy for managing severe pediatric meningococcal disease.