Clinical identification and comparative prognosis of high-risk patients with Haemophilus influenzae meningitis

N. Gary, N. Powers and J. K. Todd
Children's Hospital Kempe Research Center, Children's Hospital of Denver, CO 80218.

One hundred ninety-five consecutive children with Haemophilus influenzae meningitis were retrospectively reviewed to identify those patients at high risk of death or severe sequelae using a previously described clinical scoring system. One hundred sixty-nine children (86.7%) had prognostic scores less than or equal to 4.0 and all survived. Twenty-six patients (13.3%) had prognostic scores greater than or equal to 4.5 points. Five of these high-risk patients (2.6% overall) died as a direct result of their acute meningitis. Of the remaining 21 survivors, 15 were available for prospective, observer-blinded, follow-up evaluation, as compared with 15 low-risk control patients matched for age, sex, and year of admission. High-risk patients were significantly more likely to have more serious sequelae (2.0 +/- 2.1) as compared with low-risk controls (0.5 +/- 0.7). Those high-risk patients who by the choice of their treating physicians had received corticosteroids (and usually osmotic therapy as well) appeared to have outcomes similar to their matched low-risk controls and significantly better than those high-risk patients who did not receive such additional therapy.