The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases

Ninis, Nelly; Phillips, Claire; Bailey, Linda; Pollock, Jon; Nadel, Simon; Britto, Joseph; Maconochie, Ian; Winrow, A P; Coen, Pietro G.; Booy, Robert; Levin, Michael

doi:10.1136/bmj.330.7506.1475

Cited by 154 publications

(114 citation statements)

References 7 publications

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“…34,179,180 This most often occurs at the point of first contact between the sick child and the health care professional, and may involve a failure to understand the importance of the history, to properly examine the patient, to appropriately interpret physical signs, and make a correct diagnosis. 181,182 The introduction of treatment algorithms have been shown to improve the management of critically ill patients in the resuscitation room. 183 In a prospective cohort study of admissions to five tertiary paediatric centres, Carcillo et al identified that early reversal of shock by community physicians through the use of resuscitation protocols was associated with reduced mortality (8.69% vs 15.01%) and functional morbidity (an improved Paediatric Overall Performance category score between admission and discharge; 1.24% vs 4.23%) after controlling for severity of illness and trauma status (categorised into those with 184 There is a substantial body of literature on patient safety and adverse incidents, and there is not scope to review it within this paper.…”

Section: Individual Practicementioning

confidence: 99%

Understanding why children die in high-income countries

et al. 2014

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Copyright and reuse:The Warwick Research Archive Portal (WRAP) makes this work of researchers of the University of Warwick available open access under the following conditions. Copyright © and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable the material made available in WRAP has been checked for eligibility before being made available.Copies of full items can be used for personal research or study, educational, or not-forprofit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. AbstractThrough a structured narrative review of the literature, we have identified a wide range of factors influencing child and adolescent mortality in high income countries. These can be conceptualised within the four domains of intrinsic factors, the physical environment, the social environment, and service delivery factors. The most prominent factors in the literature are socio-economic gradients, although the mechanisms through which these gradients exert their effects are complex, affecting all four domains, and often poorly understood. While some factors are relatively fixed, including the child's gender, age, ethnicity and inherent genetic make-up, some parental characteristics, and some wider 3 environmental conditions, others may be amenable to interventions that could lessen risks and help to prevent future child deaths. A number of examples of systemic health service factors that may impact child survival are given, along with interventions such as modifications to the physical or social environmental that may impact more distal factors.

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Section: Individual Practicementioning

confidence: 99%

Understanding why children die in high-income countries

et al. 2014

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“…In Utah and Texas, while intense eff orts achieved an increase in compliance, this was still suboptimal, with the highest compliance -80 % -for intravenous fl uids, antibiotic administration and lactate evaluation [11], [12]. Delayed recognition and delayed intravenous fl uids and inotropes were also reported, along with a 36 % adherence to pre-PICU care, in a follow-up assessment of treatment guidelines for meningococcemia in the UK [15]. In India, a survey reported 12 % adherence to the ACCM guidelines among physicians; this low adherence was attributed mostly to lack of skills and knowledge [16].…”

Section: Success With Adherence To Sepsis Guidelinesmentioning

confidence: 99%

Sepsis guideline implementation: benefits, pitfalls and possible solutions

Kissoon¹

2014

Crit Care

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“…Na última década, vá-rios trabalhos demonstraram o impacto desta e de outras medidas na melhoria do prognóstico de doentes com sepsis, nomeadamente implementação de guidelines 10,11 e tratamento mais precoce e agressivo do choque. 10,11,[18][19][20] Para o comprovar, no nosso estudo, teria sido importante avaliar a precocidade no reconhecimento do choque e na abordagem terapêutica nos dois períodos, o que não foi possível por se tratar de um estudo retrospectivo.…”

Section: Discussionunclassified

Doença Invasiva Meningocócica em Cuidados Intensivos Pediátricos

et al. 2014

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Introduction:Meningococcal infection has a high mortality and morbidity in children. Aggressive initial shock approach, early referral, secondary transport and vaccination are potential factors with impact in reducing its mortality. Objectives were to characterize children admitted to intensive care due to invasive meningococcal disease, to evaluate their prognostic scores and mortality. Material and Methods: Observational study, with retrospective data collection. Two periods were created according to the year of admission (A: 2000-2005 and B: 2006-2011). Prognostic parameters, organ failure and mortality rates were compared in these groups. Results: 70 children were admitted with invasive meningococcal disease. When compared with other causes of admission, a decrease in the number of admissions due to invasive meningococcal disease was observed (period A: 3.4%; period B: 1.5%; p = 0.001). The presence of meningitis was 41% in period A and 29% in period B (p = 0.461). Rapidly progressive purpura occurred in 78% in period A and 50% in period B (p = 0.032). Children from period A had multi-organ failure (80%), disseminated intravascular coagulation (76%) and coma (22%) more frequently than children from period B (29%, 29%, 0%; p < 0.05). Mortality was 26% in period A and 0% in period B (p = 0.006) and standardized mortality by PRISM was 1.3 and 0 in period A and B respectively. Discussion: The decrease in the number of admissions due to invasive meningococcal disease can be explained by the introduction of anti-meningococcal C vaccine in 2006. Mortality decline can be possibly explained by an improvement in the initial patient stabilization and to secondary transport. Conclusion:A decrease in the number of admissions due to invasive meningococcal disease and in mortality was observed.

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The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases

Abstract: Objective To determine whether suboptimal management in hospital could contribute to poor outcome in children admitted with meningococcal disease.

Cited by 154 publications

References 7 publications

Understanding why children die in high-income countries

Understanding why children die in high-income countries

Sepsis guideline implementation: benefits, pitfalls and possible solutions

Doença Invasiva Meningocócica em Cuidados Intensivos Pediátricos

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