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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.
American Journal of Diseases of Children (1960)
|February 1, 1991
Summary
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.