title: Factors influencing neurological outcome of children with bacterial meningitis at the emergency department.
abstract: We performed a cohort study of children who survived bacterial meningitis after the neonatal period at a single pediatric center in France over a 10-year period (1995-2004) to identify predictors of death and long-term neurological deficits in children with bacterial meningitis. We performed multivariate regression to determine independent predictors of death and neurologic deficits. We identified 101 children with bacterial meningitis of which 19 died during initial hospitalization. Need for mechanical ventilation [hazard ratio (HR) 11.5, 95 % confidence interval (CI) 2.4-55.5)] and thrombocytopenia defined as a platelet count <150 × 10(9) per liter (HR 0.6, 95 % CI 0.4-0.9) at presentation were associated with death during initial hospitalization. At final assessment, 42 of the 70 survivors had no neurologic deficits identified; 20 had a single deficit, and eight had multiple deficits. A delay in initiation of antibiotics (HR 1.3, 95 % CI 1.1-1.7) and hydrocephalus on computed tomographic scan (HR 2.6, 95 % CI 1.1-6.0) were associated with having one or more long-term neurologic deficits. Identification of children at risk of death or long-term neurologic sequelae may allow therapeutic interventions to be directed to children at the highest risk.
authors.affiliation: Department of Pediatric Emergency Care, APHP-Hospital R. Debré, Paris, France.
authors.forename: Fatiha
authors.initials: F
authors.lastname: Bargui
authors.forename: Irene
authors.initials: I
authors.lastname: D'Agostino
authors.forename: Patricia
authors.initials: P
authors.lastname: Mariani-Kurkdjian
authors.forename: Corinne
authors.initials: C
authors.lastname: Alberti
authors.forename: Catherine
authors.initials: C
authors.lastname: Doit
authors.forename: Nathalie
authors.initials: N
authors.lastname: Bellier
authors.forename: Laurence
authors.initials: L
authors.lastname: Morin
authors.forename: Giuliano
authors.initials: G
authors.lastname: Galli Gibertini
authors.forename: Assia
authors.initials: A
authors.lastname: Smail
authors.forename: Anna
authors.initials: A
authors.lastname: Zanin
authors.forename: Mathie
authors.initials: M
authors.lastname: Lorrot
authors.forename: Stéphane
authors.initials: S
authors.lastname: Dauger
authors.forename: Mathieu
authors.initials: M
authors.lastname: Neve
authors.forename: Albert
authors.initials: A
authors.lastname: Faye
authors.forename: Priscilla
authors.initials: P
authors.lastname: Armoogum
authors.forename: Antoine
authors.initials: A
authors.lastname: Bourrillon
authors.forename: Edouard
authors.initials: E
authors.lastname: Bingen
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Mercier
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bonacorsi
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.forename: Luigi
authors.initials: L
authors.lastname: Titomanlio
mesh_terms: D015331:Cohort Studies; D004827:Epilepsy / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000209:etiology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008607:Intellectual Disability / Q000209:etiology; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D001523:Mental Disorders / Q000209:etiology*; D008881:Migraine Disorders / Q000209:etiology; D009069:Movement Disorders / Q000209:etiology; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000209:etiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000209:etiology; D016896:Treatment Outcome