Table 1.
Characteristics of included studies on risk factors associated with the outcomes of pediatric bacterial meningitis.
| Source | Location | Study | Age of cohort | n | Outcomes | Prevalence | Independent predictors – OR (95% CI) | |
|---|---|---|---|---|---|---|---|---|
| 1 | 1993, Kilpi | Finland | Retrospective cohort – 1984 to 1989 | 3 months to 15 years | 286 | Death, neurologic abnormalities, and subdural effusion. | 3%/15.7%/8% | Long duration of illness before hospitalization. |
| 2 | 1995, Kaaresen | Norway, Tromso | Retrospective cohort – 1980 to 1993 | 1 month to 15 years | 92 | Death, later sequelae (persisted for more than 1 y) – hydrocephalus, mental retardation, cerebral palsy, motor deficits, ataxia, hearing impairment, seizure disorder, or focal neurological findings. | 4.3%/15.2% | Duration of symptoms >48 h – OR 9.9 (1.7–56.6), seizure before admission – OR 11.2 (1.5–84.7), admission temperature >38 °C – OR 0.1 (0.02–0.9), peripheral vasoconstriction – OR 9.4 (2.0–45.3), CSF leucocytes < 1000 × 106 – OR 4.7 (1.1–21.0). |
| 3 | 1998, Chang | Taiwan | Retrospective cohort – 1989 to 1995 | Unknown | 101 | Early fatality (first 3 days after admission). | 23% | Metabolic acidosis – OR 8.31 (2.48–27.92), poor skin perfusion – OR 28.72 (3.06–268.88), extremely low CSF leukocyte count – OR 14.63 (1.44–187.14). |
| 4 | 2002, Oostenbrink | Rotterdam, Netherlands | Case-control – 1988 to 1998 | 1 month to 15 years | 170 | Death and neurological sequelae – deafness, mild hearing loss, severe mental retardation with locomotors deficits, epilepsy, mild locomotors deficits, mild mental retardation. | 8.7%/14% | Male gender – OR 3.5 (1.2–1.01), presence of atypical convulsions – OR 5.7 (1.6–20.3), lower body temperature – OR 0.5 (0.3–0.7), Pneumococcal meningitis – OR 9.1 (1.5–56.3). |
| 5 | 2005, Farag | Alexandria, Egypt | Prospective cohort study – 2002 to 2003 | 3 month to 15 years | 310 | Death and epilepsy. | 13.9%/7.1% | WHO meningitis score 9 – OR 22.7 (18.3–69.2), CSF glucose levels, H. influenzae, S. pneumonia, and N. meningitides pathogens. |
| 6 | 2008, Roine | Multicentric | Prospective cohort study | Unknown | 654 | Death, severe neurological sequelae, milder neurological sequelae. | 13%/8%/18% | Glasgow Coma Score – OR 3.67 (1.79–7.53). |
| 7 | 2009, Pelkonen | Luanda, Angola | Retrospective cohort - 2004 | 2 months to 12 years | 403 | Death, severe neurological sequelae at hospital discharge – blindness, quadriplegia and/or paresis, hydrocephalus requiring a shunt, severe psychomotor retardation. | 33%/25% | Impaired consciousness – OR 2.61 (1.44–4.72), severe dyspnea – OR 2.42 (1.17–5.03), seizures – OR 2.49 (1.36–4.58), delayed presentation – OR 3.73 (1.24–11.26), prolonged fever, secondary fever, prolonged altered consciousness, focal neurological signs, extra meningeal focus of infection, dehydration. |
| 8 | 2011, Vasilopoulou | Athens, Greece | Prospective cohort | 1 month to 14 years | 2477 | Acute complications – arthritis or subdural effusion; Sequelae – severe hearing loss, ventriculitis, hydrocephalus, seizure disorder (during 3 mo follow-up). | 6.8%/3.3% | Age <1 y at diagnosis – OR 18 (7.7–42.3), seizures on admission – OR 5.36 (2.63–10.90), symptoms duration >24 h – OR 2.1 (1.2–3.8), absence of hemorrhagic rash, low CSF glucose, high CSF protein, positive blood culture, Pneumococcal meningitis – OR 4.7 (2.5–8.8). |
| 9 | 2012, Bargui | Paris, France | Retrospective cohort – Jan 1995 to Dec 2004 | 1 month to 18 years | – | Death, neurologic deficit at the time of last 10 y follow-up visit – hearing loss, motor impairment, metal retardation, epilepsy, sleep disorders, migraine, psychiatric disorders. | 21%/40% | Mechanical ventilation – OR 11.54 (2.4–55.5), thrombocytopenia – OR 2.06 (1.07–6.08), earlier age at diagnosis – OR 1.01 (1.01–1.03), delay from onset of symptoms to initiation of therapy – OR 1.33 (1.05–1.70), hydrocephalus or initial head CT scan – OR 2.60 (1.12–6.04). |
| 10 | 2013, Namani | Republic of Kosovo | Retrospective cohort – Jan 1997 to Dec 2002, Jan 2009 to Dec 2010. | Up to 16 years | 354 | Sequelae persisting during the 2-3y follow up period – seizures, deafness, neuropsychological impairment, quadri/hemiparesia, amaurosis. | 10% | Age at diagnosis (infants) – OR 2.69 (1.62–4.59). |
| 11 | 2013, Theodoridou | Athens, Greece | Prospective cohort – 1974 to 2005 | 1 month to 14 years | 2477 | Sequelae – seizure disorder, severe hearing loss, ventriculitis, and hydrocephalus. | 3.3% | Treatment with gentamicin, trimethoprim/sulfamethoxazole, chloramphenicol, Pneumococcal meningitis – OR 10.47 (3.24–33.82), age <6 mo at diagnosis – OR 20.20 (5.55–73.55). |
| 12 | 2013, McCormick | Blantyre, Malawi | Retrospective cohort – 1997 to 2010 | 2 months to 15 years | 784 | Death, severe sequelae. | 28.7%/26.2% | Impaired consciousness – Death OR 14.4 (9.42–22.1)/sequelae OR 3.27 (2.02–5.29), HIV seropositivity - OR 1.65 (1.2–2.26), Salmonella sp. meningitis – OR 2.11 (1.06–4.08), Pneumococcal meningitis – OR 1.84 (1.03–3.29). |
| 13 | 2013, Namani | Republic of Kosovo | Prospective cohort – Jan 2009 to Dec 2010. | 1 month to 16 years | 77 | Neurological complications – subdural effusion, recurrent seizures, hemiparesis, intracerebral hemorrhage, cerebritis, facial nerve palsy, hydrocephalus, subdural hematoma, cerebral abscess, subdural empyema, and purulent ventriculitis. | 43% | Seizures prior to admission, altered mental status or focal neurological deficits at the time of admission, increased protein levels, age <12 mo – RR 2.69 (1.62–4.59). |
| 14 | 2014, Roine | Luanda, Angola | Post ROC descriptive analysis – Jul 2005 to Jun 2008 | 2 months to 12 years | 553 | Risk of dying very quickly (0–4 h), quickly (4–8 h), or after long periods. | 37% | Short disease history, shock, hypoglycemia – OR 4.47 (1.72–11.6), poor cerebrospinal fluid white cell response – OR 4.46 (1.72–11.5). |
| 15 | 2015, Corrêa | Pernambuco Brazil | Retrospective case-control study – Jan 2004 to Dec 2008. | 1 month to 14 year | 289 | Acute symptomatic seizure | 23% | Impaired mental status at admission – OR 3.47 (1.66–7.26), Pneumococcal meningitis – OR 4.55 (1.88–11.0), low CFS cell count (< 1000 cells/mm3) – OR 2.14 (0.99–4.60). |
| 16 | 2015, Olson | Guatemala | Prospective cohort – 2000 to 2007 | 0 to 59 months | 383 | Death, surviving with major morbidity – hydrocephaly, convulsions, cerebral stroke, cranial nerve paralysis. | 23.7%/27.3% | Seizure – OR 101.5, CSF glucose < 20 mg/dL – OR 5.3, symptom duration > 3 days – OR 3.7, coma – OR 6.3. |
| 17 | 2016, Wee | Singapore | Retrospective cohort – 1998 to 2013 | 3 days to 15 years | 121 | ICU admission, residual sequelae 5 y after meningitis – sensorineural hearing loss, cortical blindness, developmental delay or learning difficulties, cerebral palsy or other neuromotor deficits, hydrocephalus, epilepsy, feeding difficulty requiring assisted feeding. | 44% | Pneumococcal meningitis – OR 5.2 (1.5–18.2), leukopenia on initial blood count – OR 5.6 (1.7–17.9), CSF: serum glucose ratio <0.25 – OR 4.5 (1.4–14.4), Hib meningitis – OR 29.5 (2–429), seizures during inpatient stay requiring antiepileptic drugs – OR 10.6 (1.9–60.2), septic shock – OR 8.4 (1.1–62.1). |
CT, computed tomography; CSF; cerebral spinal fluid; ICU; intensive care unit.