The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases.
OBJECTIVE
To determine whether suboptimal management in hospital could contribute to poor outcome in children admitted with meningococcal disease.


METHODS
Case-control study of childhood deaths from meningococcal disease, comparing hospital care in fatal and non-fatal cases.


METHODS
National statistics and hospital records.


METHODS
All children under 17 years who died from meningococcal disease (cases) matched by age with three survivors (controls) from the same region of the country.


METHODS
Predefined criteria defined optimal management. A panel of paediatricians blinded to the outcome assessed case records using a standardised form and scored patients for suboptimal management.


RESULTS
We identified 143 cases and 355 controls. Departures from optimal (per protocol) management occurred more frequently in the fatal cases than in the survivors. Multivariate analysis identified three factors independently associated with an increased risk of death: failure to be looked after by a paediatrician, failure of sufficient supervision of junior staff, and failure of staff to administer adequate inotropes. Failure to recognise complications of the disease was a significant risk factor for death, although not independently of absence of paediatric care (P = 0.002). The odds ratio for death was 8.7 (95% confidence interval 2.3 to 33) with two failures, increasing with multiple failures.


CONCLUSIONS
Suboptimal healthcare delivery significantly reduces the likelihood of survival in children with meningococcal disease. Improved training of medical and nursing staff, adherence to published protocols, and increased supervision by consultants may improve the outcome for these children and also those with other life threatening illnesses.
Infectious Diseases Unit, Department of Paediatrics, Faculty of Medicine, Imperial College of Science, Technology and Medicine, London W2 1PG. ninisn@gosh.nhs.uk
Nelly
N
Ninis
Claire
C
Phillips
Linda
L
Bailey
Jon I
JI
Pollock
Simon
S
Nadel
Joseph
J
Britto
Ian
I
Maconochie
Andrew
A
Winrow
Pietro G
PG
Coen
Robert
R
Booy
Michael
M
Levin
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000592:standards; D004812:Epidemiologic Methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008589:Meningococcal Infections / Q000401:mortality* / Q000628:therapy; D006113:United Kingdom / Q000453:epidemiology