Skip to main content
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2001 Nov;85(5):382–385. doi: 10.1136/adc.85.5.382

Mortality in severe meningococcal disease

K Thorburn 1, P Baines 1, A Thomson 1, C Hart 1
PMCID: PMC1718982  PMID: 11668098

Abstract

AIM—To evaluate mortality of critically ill children admitted with meningococcal disease.
METHODS—Prospective study of all children admitted to a regional paediatric intensive care unit (PICU) between January 1995 and March 1998 with meningococcal disease. Outcome measures were actual overall mortality, predicted mortality (by PRISM), and standardised mortality ratio.
RESULTS—A total of 123 children were admitted with meningococcal disease. There was an overall PICU mortality of 11 children (8.9%). The total mortality predicted by PRISM was 24.9. The standardised mortality ratio (SMR) was 0.44. Results were compared with those from four previously published meningococcal PICU studies (USA, Australia, UK, Netherlands) in which PRISM scores were calculated. The overall PICU mortality and SMR were lower than those in the previously published studies.
CONCLUSION—Compared with older studies and calibrating for disease severity, this study found a decrease in the mortality of critically ill children with meningococcal disease.



Full Text

The Full Text of this article is available as a PDF (106.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Algren J. T., Lal S., Cutliff S. A., Richman B. J. Predictors of outcome in acute meningococcal infection in children. Crit Care Med. 1993 Mar;21(3):447–452. doi: 10.1097/00003246-199303000-00024. [DOI] [PubMed] [Google Scholar]
  2. Derkx B., Wittes J., McCloskey R. Randomized, placebo-controlled trial of HA-1A, a human monoclonal antibody to endotoxin, in children with meningococcal septic shock. European Pediatric Meningococcal Septic Shock Trial Study Group. Clin Infect Dis. 1999 Apr;28(4):770–777. doi: 10.1086/515184. [DOI] [PubMed] [Google Scholar]
  3. Derkx H. H., van den Hoek J., Redekop W. K., Bijlmer R. P., van Deventer S. J., Bossuyt P. M. Meningococcal disease: a comparison of eight severity scores in 125 children. Intensive Care Med. 1996 Dec;22(12):1433–1441. doi: 10.1007/BF01709565. [DOI] [PubMed] [Google Scholar]
  4. Gemke R. J., Bonsel G. J. Comparative assessment of pediatric intensive care: a national multicenter study. Pediatric Intensive Care Assessment of Outcome (PICASSO) Study Group. Crit Care Med. 1995 Feb;23(2):238–245. doi: 10.1097/00003246-199502000-00007. [DOI] [PubMed] [Google Scholar]
  5. Gemke R. J., Bonsel G. J., van Vught A. J. Effectiveness and efficiency of a Dutch pediatric intensive care unit: validity and application of the Pediatric Risk of Mortality score. Crit Care Med. 1994 Sep;22(9):1477–1484. doi: 10.1097/00003246-199409000-00020. [DOI] [PubMed] [Google Scholar]
  6. Hagmolen of ten Have W., Wiegman A., van den Hoek G. J., Vreede W. B., Derkx H. H. Life-threatening heart failure in meningococcal septic shock in children: non-invasive measurement of cardiac parameters is of important prognostic value. Eur J Pediatr. 2000 Apr;159(4):277–282. doi: 10.1007/s004310050070. [DOI] [PubMed] [Google Scholar]
  7. Hanley J. A., McNeil B. J. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982 Apr;143(1):29–36. doi: 10.1148/radiology.143.1.7063747. [DOI] [PubMed] [Google Scholar]
  8. Havens P. L., Garland J. S., Brook M. M., Dewitz B. A., Stremski E. S., Troshynski T. J. Trends in mortality in children hospitalized with meningococcal infections, 1957 to 1987. Pediatr Infect Dis J. 1989 Jan;8(1):8–11. doi: 10.1097/00006454-198901000-00003. [DOI] [PubMed] [Google Scholar]
  9. Levin M., Quint P. A., Goldstein B., Barton P., Bradley J. S., Shemie S. D., Yeh T., Kim S. S., Cafaro D. P., Scannon P. J. Recombinant bactericidal/permeability-increasing protein (rBPI21) as adjunctive treatment for children with severe meningococcal sepsis: a randomised trial. rBPI21 Meningococcal Sepsis Study Group. Lancet. 2000 Sep 16;356(9234):961–967. doi: 10.1016/s0140-6736(00)02712-4. [DOI] [PubMed] [Google Scholar]
  10. McManus M. L., Churchwell K. B. Coagulopathy as a predictor of outcome in meningococcal sepsis and the systemic inflammatory response syndrome with purpura. Crit Care Med. 1993 May;21(5):706–711. doi: 10.1097/00003246-199305000-00014. [DOI] [PubMed] [Google Scholar]
  11. Mok Q., Butt W. The outcome of children admitted to intensive care with meningococcal septicaemia. Intensive Care Med. 1996 Mar;22(3):259–263. doi: 10.1007/BF01712247. [DOI] [PubMed] [Google Scholar]
  12. Nadel S., Newport M. J., Booy R., Levin M. Variation in the tumor necrosis factor-alpha gene promoter region may be associated with death from meningococcal disease. J Infect Dis. 1996 Oct;174(4):878–880. doi: 10.1093/infdis/174.4.878. [DOI] [PubMed] [Google Scholar]
  13. Niklasson P. M., Lundbergh P., Strandell T. Prognostic Factors in meningococcal disease. Scand J Infect Dis. 1971;3(1):17–25. doi: 10.3109/inf.1971.3.issue-1.03. [DOI] [PubMed] [Google Scholar]
  14. Pollack M. M., Patel K. M., Ruttimann U. E. A look at pediatric intensive care--Dutch style. Crit Care Med. 1995 Feb;23(2):221–222. doi: 10.1097/00003246-199502000-00001. [DOI] [PubMed] [Google Scholar]
  15. Pollack M. M., Patel K. M., Ruttimann U. E. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med. 1996 May;24(5):743–752. doi: 10.1097/00003246-199605000-00004. [DOI] [PubMed] [Google Scholar]
  16. Pollack M. M., Ruttimann U. E., Getson P. R. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988 Nov;16(11):1110–1116. doi: 10.1097/00003246-198811000-00006. [DOI] [PubMed] [Google Scholar]
  17. Rapoport J., Teres D., Lemeshow S., Gehlbach S. A method for assessing the clinical performance and cost-effectiveness of intensive care units: a multicenter inception cohort study. Crit Care Med. 1994 Sep;22(9):1385–1391. doi: 10.1097/00003246-199409000-00006. [DOI] [PubMed] [Google Scholar]
  18. Schildkamp R. L., Lodder M. C., Bijlmer H. A., Dankert J., Scholten R. J. Clinical manifestations and course of meningococcal disease in 562 patients. Scand J Infect Dis. 1996;28(1):47–51. doi: 10.3109/00365549609027149. [DOI] [PubMed] [Google Scholar]
  19. Shann F., Carlin J. The outcome of pediatric intensive care. N Engl J Med. 1992 Apr 23;326(17):1161–1162. doi: 10.1056/NEJM199204233261713. [DOI] [PubMed] [Google Scholar]
  20. Shann F., Pearson G., Slater A., Wilkinson K. Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med. 1997 Feb;23(2):201–207. doi: 10.1007/s001340050317. [DOI] [PubMed] [Google Scholar]
  21. Shann F. Where do all the children go? Intensive Care Med. 2000 Jan;26(1):6–7. doi: 10.1007/s001340050003. [DOI] [PubMed] [Google Scholar]
  22. Sinclair J. F., Skeoch C. H., Hallworth D. Prognosis of meningococcal septicaemia. Lancet. 1987 Jul 4;2(8549):38–38. doi: 10.1016/s0140-6736(87)93067-4. [DOI] [PubMed] [Google Scholar]
  23. Stiehm E. R., Damrosch D. S. Factors in the prognosis of meningococcal infection. Review of 63 cases with emphasis on recognition and management of the severely ill patient. J Pediatr. 1966 Mar;68(3):457–467. doi: 10.1016/s0022-3476(66)80250-0. [DOI] [PubMed] [Google Scholar]
  24. Wylie P. A., Stevens D., Drake W., 3rd, Stuart J., Cartwright K. Epidemiology and clinical management of meningococcal disease in west Gloucestershire: retrospective, population based study. BMJ. 1997 Sep 27;315(7111):774–779. doi: 10.1136/bmj.315.7111.774. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. van Brakel M. J., van Vught A. J., Gemke R. J. Pediatric risk of mortality (PRISM) score in meningococcal disease. Eur J Pediatr. 2000 Apr;159(4):232–236. doi: 10.1007/s004310050060. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES