title: Factors affecting time to death from start of treatment among children succumbing to bacterial meningitis.
abstract: BACKGROUND
  Many risks of death in childhood bacterial meningitis are well-identified, but factors influencing survival time have received less attention. Better understanding of this issue could help explain why adjuvant medications have performed unevenly in different trials.
  
  
  METHODS
  In a post hoc analysis of prospectively collected data from a large bacterial meningitis treatment trial in Luanda, Angola, we compared time to death after initiation of antimicrobial treatment among 206 children with etiology and other patient characteristics. The risks of dying very quickly (0-4 hours), quickly (4-8 hours) or after longer periods were analyzed by logistic regression.
  
  
  RESULTS
  Median time to death was 18.5 hours, half the time in Streptococcus pneumoniae (11.8 hours) compared with Haemophilus influenzae (26.8 hours) meningitis. Of all deaths caused by pneumococcal or H.influenzae meningitis, 42% versus 16%, respectively, occurred within the first 8 hours. In addition, patients who succumbed within 8 hours, unlike those dying later, had a short disease history, shock, hypoglycemia and poor cerebrospinal fluid white cell response.
  
  
  CONCLUSIONS
  Time to death in Angola is so short that hardly anything, except perhaps modern intensive care, is likely to improve outcome in a patient with meningitis, especially the pneumococcal disease.
authors.affiliation: From the *Faculty of Medicine, University Diego Portales, Santiago, Chile; †Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland; ‡David Bernardino Children's Hospital, Luanda, Angola; §Children's Hospital, Helsinki University Central Hospital, and Helsinki University; ¶National Institute for Health and Welfare; and ‖Department of Otorhinolaryngology, Helsinki University Central Hospital, and Helsinki University, Helsinki, Finland.
authors.forename: Irmeli
authors.initials: I
authors.lastname: Roine
authors.forename: Tuula
authors.initials: T
authors.lastname: Pelkonen
authors.forename: Luis
authors.initials: L
authors.lastname: Bernardino
authors.forename: Manuel
authors.initials: M
authors.lastname: Leite
authors.forename: Matti
authors.initials: M
authors.lastname: Kataja
authors.forename: Anne
authors.initials: A
authors.lastname: Pitkäranta
authors.forename: Heikki
authors.initials: H
authors.lastname: Peltola
mesh_terms: D000810:Angola / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D006192:Haemophilus Infections / Q000188:drug therapy / Q000401:mortality; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D016015:Logistic Models; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000401:mortality; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D012720:Severity of Illness Index; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents