A new prognostic scoring system for meningococcal septic shock in children. Comparison with three other scoring systems.
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.
Castellanos-Ortega
Alvaro
A
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
Delgado-Rodríguez
Miguel
M
Llorca
Javier
J
Sánchez Burón
Pilar
P
Mencía Bartolomé
Santiago
S
Soult Rubio
Antonio
A
Milano Manso
Guillermo
G
Domínguez Sampedro
Pedro
P
Blanco Montero
Ramiro
R
Rodríguez Núñez
Antonio
A
Zambrano Pérez
Elisa
E
Rey Galán
Corsino
C
López Negueruela
Nuria
N
Reig Sáenz
Roberto
R
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