title: A new prognostic scoring system for meningococcal septic shock in children. Comparison with three other scoring systems.
abstract: OBJECTIVE
  To develop a quick and sensitive method for identification of children with presumed meningococcal septic shock at risk of death at admission to the pediatric intensive care unit (PICU) and to compare its performance with three other prognostic systems: Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS), Malley score and the Paediatric Index of Mortality (PIM).
  
  
  METHODS
  Multicenter retrospective cohort study.
  
  
  METHODS
  PICUs of 14 tertiary hospitals.
  
  
  METHODS
  The developmental sample included 192 children consecutively admitted to the PICUs with presumed or confirmed meningococcal septic shock from 1983 to 1995. The validation sample included 158 children consecutively admitted from 1996 to 1998.
  
  
  METHODS
  Clinical and laboratory data gathered during the first 2 h after admission were used to develop the new score and to compute the other scoring systems. Logistic regression was applied to identify the independent predictors of death.
  
  
  RESULTS
  Overall mortality was 31.5%. The new score included seven variables: cyanosis (2 points), Glasgow coma scale less than 8 (2 points), refractory hypotension (2 points), oliguria (1 point), leukocytes less than 4000/mm(3) (1 point), partial thromboplastin time more than 150% of control value (1 point) and base deficit more than 10 mmol/l (1 point). The new score provided the best discriminative capability, as measured by the area under the ROC curve (SEM) in the validation sample =0.88 (0.03), PIM =0.82 (0.04), Malley I =0.80 (0.04), GMSPS =0.79 (0.04) and Malley II =0.76 (0.04).
  
  
  CONCLUSIONS
  A new prognostic score is proposed for therapeutic stratification of children with presumed meningococcal septic shock.
authors.affiliation: Department of Intensive Care Medicine, Pediatric Intensive Care Unit, Residencia Cantabria, Hospital Universitario Marqués de Valdecilla, Avenida Cazoña s/n, 39011 Santander, Spain. uci-cantabria@humv.es
authors.forename: Alvaro
authors.initials: A
authors.lastname: Castellanos-Ortega
authors.forename: Miguel
authors.initials: M
authors.lastname: Delgado-Rodríguez
authors.forename: Javier
authors.initials: J
authors.lastname: Llorca
authors.forename: Pilar
authors.initials: P
authors.lastname: Sánchez Burón
authors.forename: Santiago
authors.initials: S
authors.lastname: Mencía Bartolomé
authors.forename: Antonio
authors.initials: A
authors.lastname: Soult Rubio
authors.forename: Guillermo
authors.initials: G
authors.lastname: Milano Manso
authors.forename: Pedro
authors.initials: P
authors.lastname: Domínguez Sampedro
authors.forename: Ramiro
authors.initials: R
authors.lastname: Blanco Montero
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodríguez Núñez
authors.forename: Elisa
authors.initials: E
authors.lastname: Zambrano Pérez
authors.forename: Corsino
authors.initials: C
authors.lastname: Rey Galán
authors.forename: Nuria
authors.initials: N
authors.lastname: López Negueruela
authors.forename: Roberto
authors.initials: R
authors.lastname: Reig Sáenz
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D008585:Meningitis, Meningococcal / Q000145:classification* / Q000401:mortality / Q000503:physiopathology; D015337:Multicenter Studies as Topic; D011379:Prognosis; D012189:Retrospective Studies; D012772:Shock, Septic / Q000145:classification* / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate