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Open Access Highly Accessed Research article

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

Rogier CJ de Jonge12*, A Marceline van Furth1, Merel Wassenaar3, Reinoud JBJ Gemke1 and Caroline B Terwee3

Author Affiliations

1 VU University Medical Center, Department of Pediatrics and Infectious Diseases, Amsterdam, The Netherlands

2 Emma Children's Hospital - Academic Medical Center, University of Amsterdam, Department of Neonatology, Amsterdam, The Netherlands

3 VU University Medical Center, Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, Amsterdam, the Netherlands

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BMC Infectious Diseases 2010, 10:232  doi:10.1186/1471-2334-10-232

Published: 5 August 2010

Abstract

Background

Bacterial meningitis (BM) is a severe infection responsible for high mortality and disabling sequelae. Early identification of patients at high risk of these outcomes is necessary to prevent their occurrence by adequate treatment as much as possible. For this reason, several prognostic models have been developed. The objective of this study is to summarize the evidence regarding prognostic factors predicting death or sequelae due to BM in children 0-18 years of age.

Methods

A search in MEDLINE and EMBASE was conducted to identify prognostic studies on risk factors for mortality and sequelae after BM in children. Selection of abstracts, full-text articles and assessment of methodological quality using the QUIPS checklist was performed by two reviewers independently. Data on prognostic factors per outcome were summarized.

Results

Of the 31 studies identified, 15 were of moderate to high quality. Due to substantial heterogeneity in study characteristics and evaluated prognostic factors, no quantitative analysis was performed. Prognostic factors found to be statistically significant in more than one study of moderate or high quality are: complaints >48 hours before admission, coma/impaired consciousness, (prolonged duration of) seizures, (prolonged) fever, shock, peripheral circulatory failure, respiratory distress, absence of petechiae, causative pathogen Streptococcus pneumoniae, young age, male gender, several cerebrospinal fluid (CSF) parameters and white blood cell (WBC) count.

Conclusions

Although several important prognostic factors for the prediction of mortality or sequelae after BM were identified, the inability to perform a pooled analysis makes the exact (independent) predictive value of these factors uncertain. This emphasizes the need for additional well-conducted prognostic studies.