A revised clinical method for assessment of severity of acute bacterial meningitis

Abstract

The aim of this study was to simplify a previously described clinical method of assessing severity of meningitis. An 8.5-point, six-item model for the risk of an abnormal course (seizures during treatment) or adverse outcome (death or recovery with neurological sequelae) was developed using a set of six bedside features: age < or = 2 yrs, 2 points; duration of illness > 7 days, 1.5 points; seizures, 2.5 points; hypovolaemic shock, 1 point; coma, 0.5 point; and abnormal muscle tone, 1 point. A high-risk score (< or = 2.5 points) was associated with a relative risk (95% CI) of 7.4 (2.4, 22.7) of seizures during treatment, and 6.3 (2.6, 17.2) for an adverse outcome (death or major or minor sequelae). The revised model should be suitable for use where laboratory facilities are not readily available, as in many developing countries, or when contra-indications to lumbar puncture are an important consideration on admission, as in severely ill patients, as well as when there are not such limitations.

Referral and previous care of children with meningitis in Nigeria: implications for the presentation and outcome of meningitis in developing countries

“…Differences between Maiduguri and Irrua in the pattern of aetiologic agents have also been described previously [26,27].…”

“…Second, there was significant intra-regional (north-south) variation in the profile of children with BM. Variation in the rate of isolation and pattern of aetiologic agents and outcome has been discussed elsewhere [26,27]. The earlier and more severe presentation of patients at Maiduguri might be partly explained by the higher prevalence of N. meningitidis/Gram negative diplococci in that centre, as meningococcal disease tends to have a more acute and dramatic presentation.…”

“…The occurrence of seizures can serve to alert the physician to both the risk of BM [20] and the risk of severe disease [6,23,27], and thus the need for referral. It is noteworthy that seizures in BM in developing countries can be difficult to control within the limits of readily available resources (Akpede et al, unpublished observations), while its prevalence has a strong correlation with the prevalence of other markers of disease severity [27]. The latter quality can be built on to formulate criteria for referral for specialist/ tertiary care.…”

Risk Factors for Death and Severe Neurological Sequelae in Childhood Bacterial Meningitis in Sub‐Saharan Africa

“…Because many clinical and laboratory features are associated with the outcome of bacterial meningitis [4][5][6][7], various scoring systems have been developed to assess the severity of the disease [8,9]. Identification of the risk factors for poor outcome at hospital admission and characterization of those risk factors that develop during the course of illness would give valuable information for clinicians attempting to find a balance between the patient's needs and existing resources.…”

Risk Factors for Death and Major Morbidity in Guatemalan Children with Acute Bacterial Meningitis

“…Predictive models have the advantage of using several individual clinical variables to create a scale of risk with greater discriminatory power. Several complex scales have been proposed for industrialized countries, but few have been validated in LMICs, especially in Latin America (5, 6). The Herson-Todd Score (HTS) was developed in the United States to predict death or major neurologic morbidity among children with Hib ABM (7).…”