title: The risk of sequelae due to pneumococcal meningitis in high-income countries: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine the risk of various kinds of sequelae in survivors of meningitis due to Streptococcus pneumoniae, as well as the influence of co-factors such as study design, study population and treatment on this risk.
  
  
  METHODS
  MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1 September 1991 to 18 June 2009 for original articles on pneumococcal meningitis sequelae. Prevalence of sequelae was pooled using random effects meta-analysis. Studies were appraised for the influence of referral bias, external validity of study populations, testing procedure and publication bias.
  
  
  RESULTS
  Data were extracted from 63 studies involving 3408 pneumococcal meningitis survivors. The pooled prevalence of any reported sequelae from 48 studies was 31.7% (95% confidence interval 27.2-36.3%) using a random effects model (Cochran-Q = 277, p < 0.01). Differences in studies due to design, study population and treatment were not significant. The pooled prevalence of hearing loss, seizures, hydrocephalus, spasticity/paresis, cranial nerve palsies and visual impairment was 20.9% (17.1-24.7%), 6.5% (3.3-9.7%), 6.8% (3.3-10.2%), 8.7% (6.4-11.0%), 12.2% (5.3-19.1%) and 2.4% (0-5.7%) respectively.
  
  
  CONCLUSIONS
  The burden of sequelae due to pneumococcal meningitis remains high in the reviewed studies.
authors.affiliation: Modelling and Economics Unit, Health Protection Agency Centre for Infections, London, UK. mark.jit@hpa.org.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Jit
mesh_terms: D003389:Cranial Nerve Diseases / Q000453:epidemiology* / Q000209:etiology; D019049:Developed Countries; D034381:Hearing Loss / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology* / Q000209:etiology; D008586:Meningitis, Pneumococcal / Q000150:complications*; D015995:Prevalence; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology; D013296:Streptococcus pneumoniae / Q000472:pathogenicity*; D014786:Vision Disorders / Q000453:epidemiology* / Q000209:etiology