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Factors affecting outcome in meningococcal infections
1Division of General Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine 19104.
Abstract:
A prognostic score for evaluating meningococcal infections in patients consists of the following five features that indicate a poor prognosis: onset of petechiae within 12 hours of presentation; shock; normal or low peripheral leukocyte count; normal or low erythrocyte sedimentation rate; and absence of meningitis. Based on our experience and some published data, we suspected that the score may no longer be reliable. We reviewed the charts of 73 children with meningococcal infection from December 19, 1979 to December 19, 1987 and applied the prognostic score mentioned previously. Our findings indicate that although a low score is generally associated with a good outcome, a higher score is less predictive of poor outcome than previously suggested. A rash with petechiae or purpura, the presence of shock, and a normal or low peripheral leukocyte count continue to be predictors of poor outcome. Erythrocyte sedimentation rate was not evaluated owing to a limited amount of data. The absence of meningitis did not correlate with a worse outcome in our patients. Most patients who died had evidence of meningeal involvement at the time of presentation. Instead, altered mental status at presentation, particularly obtundation or coma, was an ominous sign. We conclude that absence of meningitis is not a good predictor of outcome, as was previously thought. Altered mental status at the time of presentation may prove to be a stronger indicator of poor outcome.
Insights
The established prognostic score for meningococcal infections may be unreliable. Altered mental status, shock, and rash are key indicators of poor outcomes in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- A previously established prognostic score for meningococcal infections included five features indicating poor prognosis.
- Concerns arose regarding the score's current reliability based on clinical experience and existing data.
Purpose of the Study:
- To re-evaluate the prognostic score for meningococcal infections in children.
- To identify reliable predictors of poor outcomes in pediatric meningococcal disease.
Main Methods:
- A retrospective chart review of 73 children diagnosed with meningococcal infection between 1979 and 1987.
- Application of the established prognostic score to assess its predictive value.
Main Results:
- A low prognostic score generally correlated with good outcomes, but higher scores were less predictive of poor outcomes than previously suggested.
- Predictors of poor outcome included rash (petechiae or purpura), shock, and low peripheral leukocyte count.
- Absence of meningitis did not correlate with worse outcomes; meningeal involvement was noted in most fatal cases.
- Altered mental status (obtundation or coma) at presentation emerged as a significant indicator of poor prognosis.
Conclusions:
- The absence of meningitis is not a reliable predictor of outcome in pediatric meningococcal infections.
- Altered mental status at presentation is a stronger indicator of poor prognosis than previously recognized.
- Key indicators of poor prognosis in meningococcal infections include rash, shock, and altered mental status.