title: Long-term skin scarring and orthopaedic sequelae in survivors of meningococcal septic shock.
abstract: OBJECTIVE
  To assess the incidence of skin scarring and orthopaedic sequelae (amputation, limb-length discrepancy) in patients who survived meningococcal septic shock (MSS) in childhood and to determine the severity and predictors of these sequelae.
  
  
  METHODS
  179 consecutive patients (170 of whom were eligible) with septic shock and purpura requiring intensive care between 1988 and 2001 in Rotterdam, the Netherlands were invited to visit a follow-up clinic 4-16 years after paediatric intensive care unit (PICU) discharge.
  
  
  RESULTS
  58 (48%) of 120 follow-up patients (median follow-up interval 10 years; median age at follow-up 14.5 years) had skin scarring due to purpura. This varied from barely visible to extremely disfiguring scars. Ten patients (8%) had undergone amputation(s) of extremities, ranging from one toe to both legs and one arm. Seven patients (6%) had lower limb-length discrepancy, in most cases together with angular deformity, requiring one or more late surgical intervention(s). Patients with scars or orthopaedic sequelae had significantly higher severity of illness scores, determined by the Pediatric Risk of Mortality score, Vasopressor score and Disseminated Intravascular Coagulation score. Gender or Neisseria meningitidis serogroup had no significant influence on the presence of scars or orthopaedic sequelae. Patients with lower limb-length discrepancy were significantly younger at the time of PICU admission.
  
  
  CONCLUSIONS
  The incidence of long-term skin scarring and orthopaedic sequelae was high (48% and 14%, respectively) in patients who survived MSS in childhood. The severity of these sequelae varied from mild to severe. Patients with scars or orthopaedic sequelae had significantly higher severity of illness scores.
authors.affiliation: Division of Paediatric Intensive Care, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. c.buysse@erasmusmc.nl
authors.forename: C M P
authors.initials: CM
authors.lastname: Buysse
authors.forename: A P
authors.initials: AP
authors.lastname: Oranje
authors.forename: E
authors.initials: E
authors.lastname: Zuidema
authors.forename: J A
authors.initials: JA
authors.lastname: Hazelzet
authors.forename: W C J
authors.initials: WC
authors.lastname: Hop
authors.forename: A F
authors.initials: AF
authors.lastname: Diepstraten
authors.forename: K F M
authors.initials: KF
authors.lastname: Joosten
mesh_terms: D000293:Adolescent; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007870:Leg Length Inequality / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008589:Meningococcal Infections / Q000150:complications*; D009426:Netherlands; D011693:Purpura / Q000150:complications*; D011788:Quality of Life; D012649:Self Concept; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000150:complications*; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome