Prognostic factors in acute bacterial meningitis in children. A case control study

Background: The prognosis of acute bacterial meningitis continues to be poo r in our country. Previous studies suggest that the delay in diagnosis has an important prognostic value. Aim: To study the influence of diagnosis tim ing and the clinical conditions of children with acute bacterial meningitis on admission on death and incidence of gross sequelae. Patients and method s: Charts of children deceased or discharged with gross sequelae as consequ ence of an acute bacterial meningitis were selected. To each of these cases , 4 children with the same diagnosis but discharged in good conditions were selected as controls. Variables recorded were time and number of visits pr evious to the diagnosis, etiology of meningitis, neurological, respiratory, digestive and hemodynamic involvement on admission. Results: Fifty seven c ases and 224 controls were studied. Most cases were 12 months old or less ( OR 4.1, 95% CI= 1.97-8.7). Diagnosis made on the first visit or within the first 24 hours of disease, improved prognosis (OR 0.25, 95% CI= 0.07-0.78). An age of less than 12 months and a diagnosis made after more than 12 hour s of disease or after more than one consultation interacted multiplying the ir effect on a dismal prognosis. Coma on admission (OR 7 95% CI= 3-14.3) an d S Pneumoniae etiology (OR 7, CI 95%= 3.4, 14.3) were also associated with a bad prognosis. Conclusions: Early diagnosis od acute bacterial meningiti s is protective for death or gross sequelae at discharge. Age, coma and S P neumoniae etiology are the main factors associated with a poor prognosis.