Predictors of permanent neurologic sequelae or death following bacterial meningitis were determined in a case-controlled study at Sophia Children’s Hospital, Rotterdam, The Netherlands. The study population of 93 children presenting with meningeal signs included 23 cases with neurologic sequelae and 70 controls without sequelae (52% boys, median age 2.8 yrs). Of the 23 cases, 2 died (8.7%), 6 were deaf (26.1%), 8 had mild hearing loss (34.7%), 4 were severely retarded (17.4%) and 3 had epilepsy, mild locomotor deficits or mild mental retardation (13%). Significant independent predictors for an adverse outcome were male gender, the occurrence of atypical convulsions before admission (duration >15 min, non-generalized jerks, incomplete recovery, multiple convulsions within 24 hr), low body temperature at admission, and especially, the pathogen type Streptococcus pneumoniae. The area under the ROC curve (estimated predictive performance) of this prediction rule was 0.87 (95% confidence interval: 0.78-0.96). A risk score computed for each patient by assigning points for each predictor present was used to classify patients into adverse outcome categories. [1]
COMMENT. Permanent neurological sequelae or death after bacterial meningitis in childhood may be predicted from the early clinical characteristics. The pathogen type, Streptococcus pneumoniae is the strongest predictor of poor outcome. Additional independent predictors of adverse outcome are male gender, history of atypical convulsions, and low body temperature. Clinical characteristics and laboratory tests during the recovery period are not of value as risk predictors.