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Early prediction of neurological sequelae or death after bacterial meningitis
R Oostenbrink1, K G M Moons, G Derksen-Lubsen
1Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands. oostenbrink@alkg.azr.nl
Insights
Predicting adverse outcomes in childhood bacterial meningitis is possible using early clinical factors. Male gender, atypical seizures, low temperature, and Streptococcus pneumoniae infection predict permanent neurological sequelae or death.
Area of Science:
- Pediatric Infectious Diseases
- Neurology
- Epidemiology
Background:
- Childhood bacterial meningitis poses a significant risk for permanent neurological sequelae or death.
- Early identification of high-risk patients is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To determine independent predictors of permanent neurological sequelae or death following childhood bacterial meningitis.
- To develop a predictive model for adverse outcomes in pediatric bacterial meningitis.
Main Methods:
- Nested case-control study design utilizing data from a large cohort of children (1 month to 15 years).
- Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were employed to identify predictors.
- Predictors were derived from clinical evaluations and laboratory tests at presentation and during the clinical course.
Main Results:
- Independent predictors for adverse outcomes included male gender, atypical convulsions, low body temperature on admission, and infection with Streptococcus pneumoniae.
- The developed prediction rule demonstrated strong predictive accuracy with an area under the ROC curve of 0.87.
- The inclusion of additional characteristics did not significantly improve the predictive power of the model.
Conclusions:
- Early clinical characteristics, including gender, seizure history, admission temperature, and pathogen type, are significant predictors of adverse outcomes in childhood bacterial meningitis.
- Streptococcus pneumoniae is identified as a particularly important prognostic determinant.
- A predictive score based on these factors can effectively stratify patients by risk for permanent neurological sequelae or death.
Unlabelled:
This study determined independent predictors of the occurrence of permanent neurological sequelae or death after childhood bacterial meningitis. Data were used from a large study on children (aged 1 mo to 15 y) initially presenting with meningeal irritation. A nested case-control study was performed on children with (n = 23) and without (n = 70) permanent neurological sequelae (hearing impairment, locomotor dysfunction, mental retardation or epilepsy) or death after bacterial meningitis. Predictors obtained from clinical evaluation and laboratory tests at presentation and during the clinical course were identified by multivariate logistic regression and receiver operating characteristic (ROC) curve analyses. The study population comprised 23 cases and 70 controls (52% boys, median age 2.8 y). Independent predictors for an adverse outcome after bacterial meningitis were male gender, atypical convulsions in history, low body temperature at admission and the pathogen Streptococcus pneumoniae. The area under the ROC curve of this prediction rule was 0.87 (95% confidence interval: 0.78-0.96), which was not improved by adding other characteristics. A score including these independent predictors could classify patients into categories with increasing risk for an adverse outcome.
Conclusion:
Clinical characteristics available early in the clinical course, such as gender, atypical convulsions in history, low body temperature at admission and the pathogen, are predictive for the occurrence of permanent neurological sequelae or death after bacterial meningitis in childhood. The pathogen type, in particular, is the main prognostic determinant of childhood bacterial meningitis.