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Factors influencing neurological outcome of children with bacterial meningitis at the emergency department

Abstract

We performed a cohort study of children who survived bacterial meningitis after the neonatal period at a single pediatric center in France over a 10-year period (1995–2004) to identify predictors of death and long-term neurological deficits in children with bacterial meningitis. We performed multivariate regression to determine independent predictors of death and neurologic deficits. We identified 101 children with bacterial meningitis of which 19 died during initial hospitalization. Need for mechanical ventilation [hazard ratio (HR) 11.5, 95 % confidence interval (CI) 2.4–55.5)] and thrombocytopenia defined as a platelet count <150 × 109 per liter (HR 0.6, 95 % CI 0.4–0.9) at presentation were associated with death during initial hospitalization. At final assessment, 42 of the 70 survivors had no neurologic deficits identified; 20 had a single deficit, and eight had multiple deficits. A delay in initiation of antibiotics (HR 1.3, 95 % CI 1.1–1.7) and hydrocephalus on computed tomographic scan (HR 2.6, 95 % CI 1.1–6.0) were associated with having one or more long-term neurologic deficits. Identification of children at risk of death or long-term neurologic sequelae may allow therapeutic interventions to be directed to children at the highest risk.

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Fig. 1

Abbreviations

BUN:

Blood urea nitrogen

CSF:

Cerebrospinal fluid

GBS:

Group B Streptococcus

GCS:

Glasgow coma scale

ICU:

Intensive care unit

OR:

Odds ratio

RBC:

Red blood cells

WBC:

White blood cells

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Financial disclosure statement

All authors declare complete disclosure of financial relationship with any manufacturer whose product is discussed in the manuscript.

Author contribution

Fatiha Bargui and Irene D’Agostino: acquisition of data, drafting the manuscript.

Corinne Alberti and Priscilla Armoogum: statistical analysis, revising the manuscript.

Nathalie Bellier, Laurence Morin, Giuliano Galli Gibertini, Assia Smail, Patricia Mariani-Kurkdjian, Catherine Doit, Stéphane Bonacorsi, Mathie Lorrot, Stéphane Dauger, Mathieu Neve, and Albert Faye: acquisition of data, revising the article.

Anna Zanin, Antoine Bourrillon, Edouard Bingen, Jean-Christophe Mercier, and Lise E. Nigrovic: interpretation of data, revising the manuscript.

Luigi Titomanlio: conception and design, interpretation of data, revising the manuscript.

Author information

Correspondence to Luigi Titomanlio.

Additional information

Fatiha Bargui and Irene D’Agostino contributed equally.

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Bargui, F., D’Agostino, I., Mariani-Kurkdjian, P. et al. Factors influencing neurological outcome of children with bacterial meningitis at the emergency department. Eur J Pediatr 171, 1365–1371 (2012). https://doi.org/10.1007/s00431-012-1733-5

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Keywords

  • Bacterial meningitis
  • Neurological outcome
  • Long-term sequelae
  • Neurologic deficits