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Risk factors for adverse outcomes of bacterial meningitis
K Grimwood1, T M Nolan, L Bond
1Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
Insights
Identifying risk factors for bacterial meningitis in children is crucial. Young age, prolonged symptoms, seizures, and neurological signs predict severe outcomes, necessitating early assessment for all survivors.
Area of Science:
- Pediatric Infectious Diseases
- Neurology
- Epidemiology
Background:
- Bacterial meningitis poses significant risks for children, leading to mortality and long-term sequelae.
- Early identification of risk factors can improve patient outcomes and inform clinical management.
Purpose of the Study:
- To identify independent risk factors associated with adverse outcomes in children following bacterial meningitis.
- To evaluate the predictive value of early clinical indicators for long-term sequelae.
Main Methods:
- Prospective cohort study of 166 children diagnosed with bacterial meningitis.
- Long-term follow-up assessments (neurological, neuropsychological, audiological, behavioral) conducted 5-9 years post-illness on survivors.
Main Results:
- Major adverse outcomes included death (4.8%) and severe sequelae (8.5%). Minor disabilities affected 18.5% of survivors.
- Independent risk factors identified: age ≤12 months, symptoms >24h, seizures after 72h, and focal neurological signs.
- These factors were present in 95% of children with major sequelae.
Conclusions:
- Predicting minor disabilities post-meningitis remains challenging.
- All children surviving bacterial meningitis require comprehensive assessment during their early school years to detect potential developmental issues.
Objective:
To identify risk factors for adverse outcomes from bacterial meningitis.
Methodology:
From a cohort of 166 children with bacterial meningitis who were studied prospectively, 130/158 (82%) survivors underwent neurological, neuropsychological, audiological and behaviour assessments 5-9 years following their illness.
Results:
Major adverse outcomes included B/166 (4.8%) deaths and severe neurological, intellectual or audiological sequelae in 11/130 (8.5%) children followed. Another 24 (18.5%) had cognitive, auditory or behaviour disorders. Bivariate analysis found age < or = 12 months, tertiary referral, symptoms > 24 h before diagnosis, seizures, focal neurological signs, deteriorating conscious state in hospital, Streptococcus pneumoniae infection and serum sodium concentration < 130 mmol/L were associated with adverse outcomes. Multivariate analysis showed age < or = 12 months, symptoms > 24 h, seizures after 72 h in hospital and focal neurological signs as independent risk factors. These were present in 18/19 (95%) children with major sequelae, but absent in 9/24 (37.5%) children with minor disabilities.
Conclusions:
As minor disabilities following meningitis cannot be predicted, all survivors require assessment during their early school years.