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

de Jonge RC, van Furth AM, Wassenaar M, Gemke RJ, Terwee CB - BMC Infect. Dis. (2010)

Bottom Line: Data on prognostic factors per outcome were summarized.Of the 31 studies identified, 15 were of moderate to high quality.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: VU University Medical Center, Department of Pediatrics and Infectious Diseases, Amsterdam, The Netherlands. r.c.dejonge@amc.nl

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.

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Related in: MedlinePlus

Selection and number of publications.
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Figure 1: Selection and number of publications.

Mentions: Figure 1 presents a flow chart of the study selection. The search strategy yielded 6,963 citations. Of these, 43 articles seemed to fulfill the inclusion criteria and were retrieved in full text. Two additional articles were identified by checking the reference lists. Review of these 45 articles resulted in exclusion of 14 articles not meeting the inclusion criteria. Eleven studies were excluded based on design (one letter, one validation study and nine presenting an association model instead of a prognostic model), one study dealt with diagnosis (prediction of meningitis instead of sequelae), and two studies were excluded because no differentiation was made between viral or aseptic and BM for outcome measurement. Finally, 31 articles were included and assessed on methodological quality.


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

de Jonge RC, van Furth AM, Wassenaar M, Gemke RJ, Terwee CB - BMC Infect. Dis. (2010)

Selection and number of publications.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2921388&req=5

Figure 1: Selection and number of publications.
Mentions: Figure 1 presents a flow chart of the study selection. The search strategy yielded 6,963 citations. Of these, 43 articles seemed to fulfill the inclusion criteria and were retrieved in full text. Two additional articles were identified by checking the reference lists. Review of these 45 articles resulted in exclusion of 14 articles not meeting the inclusion criteria. Eleven studies were excluded based on design (one letter, one validation study and nine presenting an association model instead of a prognostic model), one study dealt with diagnosis (prediction of meningitis instead of sequelae), and two studies were excluded because no differentiation was made between viral or aseptic and BM for outcome measurement. Finally, 31 articles were included and assessed on methodological quality.

Bottom Line: Data on prognostic factors per outcome were summarized.Of the 31 studies identified, 15 were of moderate to high quality.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: VU University Medical Center, Department of Pediatrics and Infectious Diseases, Amsterdam, The Netherlands. r.c.dejonge@amc.nl

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.

Show MeSH
Related in: MedlinePlus