Usefulness of Clinical Scores to Predict Outcome in Bacterial Meningitis

Abstract

The predictive usefulness of clinical scores in patients with acute bacterial meningitis was investigated. Fifty-one consecutive patients with acute bacterial meningitis were scored on days 1, 3, 5, 8, and 14 after admission according to the Sandinavian Stroke Scale (SSS), Glasgow Coma-Scale (GCS) and Hunt & Hess Scale (HH). As an index of their usefulness to predict the outcome, the scales were correlated with short-term outcome on day 21 assessed by the Glasgow Outcome Scale (GOS). The scores of all three scales correlated highly significantly with short-term outcome. Depending on the day of assessment, Spearman correlation coefficients ranged between 0.52 and 0.88 for SSS, between 0.50 and 0.84 for GCS, and between -0.47 and -0.82 for HH. The scales differed in their ability to predict outcome on and after day 1: mortality was best predicted by GCS, and complete recovery was best predicted by SSS. The use of scales in bacterial meningitis provides a rational quantitative basis to predict outcome more graduated than in dead or alive. Because the scales accentuate different aspects of outcome (e.g. mortality, restitution), the selection of a scale to be used in clinical trials should take into consideration the main focus of the study.

Neuro-Intensive Treatment Targeting Intracranial Hypertension Improves Outcome in Severe Bacterial Meningitis: An Intervention-Control Study

“…Acute bacterial meningitis (ABM) in adults still remains a challenge for the clinician, and in comatose ABM-patients mortality rates of up to 62% have been reported [2], [9], [10]. ICP-targeting treatment of severe ABM has been reported with promising results [14]–[16], [23] but is not routinely used.…”

“…A power test was performed, based on available data [2], [8]–[10], [12], [14]–[16] suggesting a mortality of 40% with standard ICU treatment, and hypothesizing a 20% mortality when employing ICP-targeted treatment of ABM patients with severely impaired mental status at the NICU. Consequently, at least 50 patients are required in each group to achieve a probability of 80% to detect a 20% difference in mortality with a 95% CI.…”

Diagnostic Characteristics of Symptom Combinations over Time in Meningitis Patients

“…Herein, we applied criteria commonly used in previous studies; 5,8 however, other sets of criteria have also been reported. Merkelbach et al used a criterion that defined meningitis only by pleocytosis with neutrophilia of CSF, 12 whereas Chavanet et al used more stringent criteria in which the WBC count was added to the criteria used in this study. 13 We applied those criteria to this study and regardless of the difference in criteria, the same results were observed that only one subject was alert at third day from the onset of fever and no subjects was alert at fourth day from the onset of fever.…”

The role of ICP monitoring in meningitis

“…22,53 In addition, patients presenting with a GCS score ≤ 8 have significantly higher mortality rates compared with patients with a GCS score ≥ 12, which is consistent with the fact that elevated ICP is more prevalent among patients with a lower GCS score. 11,25,32,44,52 ICP may vary considerably through the course of the disease and regular ICP monitoring in select cases has been linked to improved outcomes. In a recent retrospective study in Europe, Depreitere et al evaluated clinical outcomes in 17 patients with severe bacterial meningitis whose ICP was monitored.…”