Factors affecting outcome in meningococcal infections
L. J. Tesoro and S. M. Selbst
Division of General Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine 19104.
A prognostic score for evaluating meningococcal infections in patients
consists of the following five features that indicate a poor prognosis:
onset of petechiae within 12 hours of presentation; shock; normal or low
peripheral leukocyte count; normal or low erythrocyte sedimentation rate;
and absence of meningitis. Based on our experience and some published data,
we suspected that the score may no longer be reliable. We reviewed the
charts of 73 children with meningococcal infection from December 19, 1979
to December 19, 1987 and applied the prognostic score mentioned previously.
Our findings indicate that although a low score is generally associated
with a good outcome, a higher score is less predictive of poor outcome than
previously suggested. A rash with petechiae or purpura, the presence of
shock, and a normal or low peripheral leukocyte count continue to be
predictors of poor outcome. Erythrocyte sedimentation rate was not
evaluated owing to a limited amount of data. The absence of meningitis did
not correlate with a worse outcome in our patients. Most patients who died
had evidence of meningeal involvement at the time of presentation. Instead,
altered mental status at presentation, particularly obtundation or coma,
was an ominous sign. We conclude that absence of meningitis is not a good
predictor of outcome, as was previously thought. Altered mental status at
the time of presentation may prove to be a stronger indicator of poor
outcome.
