FACTORS ASSOCIATED WITH FATAL OUTCOME IN CHILDHOOD MENINGOCOCCAL DISEASE

The purpose of this study was to identify factors associated with a fa tal outcome in children with meningococcal disease and to design a new clinical scoring system. We reviewed the charts of all 137 children w ith meningococcal disease admitted alive to the University Hospital, T romso, during the years 1977-92. Twelve of the children died (8.7%). O n admission the following clinical signs were significantly associated with poor outcome: peripheral vasoconstriction, cyanosis, extensive p etechiae, hypotension, altered consciousness, hyperventilation and abs ence of neck rigidity. The laboratory parameters low pH, low base exce ss, thrombocytopenia, low Trombotest and leukopenia were also associat ed with later death. Multiple logistic regression was performed to exa mine the independent effect of each variable. Cyanosis, peripheral vas oconstriction and base excess < - 10 mmol/l or pH < 7.35 were signific antly associated with a fatal outcome. A clinical scoring system based on the extent of petechiae, the presence of peripheral vasoconstricti on, hyperventilation and/or cyanosis, the absence of neck rigidity and impairment of consciousness is proposed. Twenty-nine patients receive d greater than or equal to 3.5 points, of whom 12 died and 12 survived . None of the patients who died had less than 3.5 points. The clinical scoring system is based solely on clinical signs. It can be done rapi dly and performs well in identifying children who might benefit from e arly intensive care.