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Factors associated with fatal outcome in childhood meningococcal disease
T Flaegstad1, P I Kaaresen, T Stokland
1Department of Pediatrics, University of Tromsø, Norway.
Insights
Identifying children with meningococcal disease who are at high risk of death is crucial. This study found that cyanosis, peripheral vasoconstriction, and specific blood gas values are key indicators of a fatal outcome in pediatric cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Meningococcal disease is a serious infection in children.
- Identifying prognostic factors for fatal outcomes is essential for timely intervention.
Purpose of the Study:
- To identify clinical and laboratory factors associated with fatal outcomes in pediatric meningococcal disease.
- To develop a novel clinical scoring system for risk stratification.
Main Methods:
- Retrospective chart review of 137 children with meningococcal disease admitted alive.
- Analysis of clinical signs and laboratory parameters on admission.
- Logistic regression to determine independent predictors of mortality.
- Development and validation of a clinical scoring system.
Main Results:
- Clinical signs associated with poor outcome included peripheral vasoconstriction, cyanosis, hypotension, altered consciousness, and absence of neck rigidity.
- Laboratory indicators of poor outcome included low pH, low base excess, and thrombocytopenia.
- Cyanosis, peripheral vasoconstriction, and specific acid-base disturbances (base excess < -10 mmol/l or pH < 7.35) were independently associated with fatal outcomes.
- The proposed clinical scoring system, based on clinical signs, showed promise in identifying high-risk children.
Conclusions:
- Clinical signs such as cyanosis and peripheral vasoconstriction, along with acid-base status, are critical predictors of mortality in pediatric meningococcal disease.
- A rapid, clinical-signs-based scoring system can effectively identify children requiring intensive care, potentially improving survival rates.
Abstract:
The purpose of this study was to identify factors associated with a fatal outcome in children with meningococcal disease and to design a new clinical scoring system. We reviewed the charts of all 137 children with meningococcal disease admitted alive to the University Hospital, Tromsø, during the years 1977-92. Twelve of the children died (8.7%). On admission the following clinical signs were significantly associated with poor outcome: peripheral vasoconstriction, cyanosis, extensive petechiae, hypotension, altered consciousness, hyperventilation and absence of neck rigidity. The laboratory parameters low pH, low base excess, thrombocytopenia, low Trombotest and leukopenia were also associated with later death. Multiple logistic regression was performed to examine the independent effect of each variable. Cyanosis, peripheral vasoconstriction and base excess < -10 mmol/l or pH < 7.35 were significantly associated with a fatal outcome. A clinical scoring system based on the extent of petechiae, the presence of peripheral vasoconstriction, hyperventilation and/or cyanosis, the absence of neck rigidity and impairment of consciousness is proposed. Twenty-nine patients received > or = 3.5 points, of whom 12 died and 12 survived. None of the patients who died had less than 3.5 points. The clinical scoring system is based solely on clinical signs. It can be done rapidly and performs well in identifying children who might benefit from early intensive care.