Reduction in case fatality rate from meningococcal disease associated withimproved healthcare delivery

Background and aims-The case fatality rate from meningococcal. disease (MD) has remained relatively unchanged in the post antibiotic era, with 20-50% of patients who develop shock still dying. In 1992 a new paediatric intensi ve care unit (PICU) specialising in MD was opened. Educational information was disseminated to local hospitals, and a specialist transport service was established which delivered mobile intensive care. The influence of these changes on mortality of children with MD was investigated. Methods-A total of 331 consecutive children with meningococcal disease admi tted to the PICU between 1992 and 1997 were studied. Severity of the diseas e on admission was assessed using the paediatric risk of mortality (PRISM) score. Logistic regression analysis was used to correct for clinical severi ty, age, and sex; death was the outcome, and year of admission, a temporal trend variable, was the primary exposure. Results-The case fatality rate fell year on year (from 23% in 1992/93 to 2% in 1997) despite disease severity remaining largely unchanged. After adjus tment for age, sex, and disease severity, the overall estimate for improvem ent in the odds of death was 59% per year (odds ratio for the yearly trend 0.41). Conclusions-A significant improvement in outcome for children admitted with MD to a PICU has occurred in association with improvements in initial mana gement of patients with MD at referring hospitals, use of a mobile intensiv e care service, and centralisation of care in a specialist unit.