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Predicting sequelae and death after bacterial meningitis in childhood: a systematic review of prognostic studies

Rogier C J de Jonge1, A Marceline van Furth, Merel Wassenaar

  • 1VU University Medical Center, Department of Pediatrics and Infectious Diseases, Amsterdam, The Netherlands. r.c.dejonge@amc.nl

BMC Infectious Diseases
|August 6, 2010
PubMed

Insights

Identifying bacterial meningitis (BM) risk factors in children is crucial. Key indicators for poor outcomes include prolonged symptoms, coma, seizures, shock, and specific lab results, though more research is needed.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Epidemiology
  • Prognostic Factor Research

Background:

  • Bacterial meningitis (BM) is a severe childhood infection with high mortality and long-term disability risks.
  • Early identification of high-risk pediatric patients is essential for timely and effective treatment.
  • Existing prognostic models for BM outcomes require further validation and refinement.

Purpose of the Study:

  • To systematically review and summarize evidence on prognostic factors predicting death or sequelae in children (0-18 years) with bacterial meningitis.
  • To identify key clinical and laboratory indicators associated with adverse outcomes in pediatric BM.
  • To assess the current state of research on prognostic factors for pediatric BM.

Main Methods:

  • Conducted a systematic literature search in MEDLINE and EMBASE for prognostic studies on pediatric BM.
  • Two independent reviewers selected studies, assessed methodological quality using the QUIPS checklist, and extracted data.
  • Summarized identified prognostic factors for mortality and sequelae outcomes.

Main Results:

  • Analyzed 31 studies; 15 were of moderate to high quality.
  • Substantial heterogeneity precluded quantitative (pooled) analysis.
  • Significant prognostic factors identified in multiple studies include: prolonged symptoms (>48h), impaired consciousness/coma, seizures, fever, shock, respiratory distress, absence of petechiae, *Streptococcus pneumoniae* infection, young age, male gender, CSF parameters, and WBC count.

Conclusions:

  • Several prognostic factors for pediatric BM mortality and sequelae have been identified.
  • The predictive value of these factors remains uncertain due to the inability to perform a pooled analysis.
  • There is a clear need for well-designed, prospective prognostic studies in pediatric bacterial meningitis.
Abstract

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