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Factors influencing neurological outcome of children with bacterial meningitis at the emergency department

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Abstract

We performed a cohort study of children who survived bacterial meningitis after the neonatal period at a single pediatric center in France over a 10-year period (1995–2004) to identify predictors of death and long-term neurological deficits in children with bacterial meningitis. We performed multivariate regression to determine independent predictors of death and neurologic deficits. We identified 101 children with bacterial meningitis of which 19 died during initial hospitalization. Need for mechanical ventilation [hazard ratio (HR) 11.5, 95 % confidence interval (CI) 2.4–55.5)] and thrombocytopenia defined as a platelet count <150 × 109 per liter (HR 0.6, 95 % CI 0.4–0.9) at presentation were associated with death during initial hospitalization. At final assessment, 42 of the 70 survivors had no neurologic deficits identified; 20 had a single deficit, and eight had multiple deficits. A delay in initiation of antibiotics (HR 1.3, 95 % CI 1.1–1.7) and hydrocephalus on computed tomographic scan (HR 2.6, 95 % CI 1.1–6.0) were associated with having one or more long-term neurologic deficits. Identification of children at risk of death or long-term neurologic sequelae may allow therapeutic interventions to be directed to children at the highest risk.

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Abbreviations

BUN:

Blood urea nitrogen

CSF:

Cerebrospinal fluid

GBS:

Group B Streptococcus

GCS:

Glasgow coma scale

ICU:

Intensive care unit

OR:

Odds ratio

RBC:

Red blood cells

WBC:

White blood cells

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Financial disclosure statement

All authors declare complete disclosure of financial relationship with any manufacturer whose product is discussed in the manuscript.

Author contribution

Fatiha Bargui and Irene D’Agostino: acquisition of data, drafting the manuscript.

Corinne Alberti and Priscilla Armoogum: statistical analysis, revising the manuscript.

Nathalie Bellier, Laurence Morin, Giuliano Galli Gibertini, Assia Smail, Patricia Mariani-Kurkdjian, Catherine Doit, Stéphane Bonacorsi, Mathie Lorrot, Stéphane Dauger, Mathieu Neve, and Albert Faye: acquisition of data, revising the article.

Anna Zanin, Antoine Bourrillon, Edouard Bingen, Jean-Christophe Mercier, and Lise E. Nigrovic: interpretation of data, revising the manuscript.

Luigi Titomanlio: conception and design, interpretation of data, revising the manuscript.

Author information

Authors and Affiliations

  1. Department of Pediatric Emergency Care, APHP-Hospital R. Debré, Paris, France

    Fatiha Bargui, Irene D’Agostino, Nathalie Bellier, Laurence Morin, Giuliano Galli Gibertini, Assia Smail, Anna Zanin, Jean-Christophe Mercier & Luigi Titomanlio

  2. INSERM, UMR 676, Paris, France

    Irene D’Agostino & Luigi Titomanlio

  3. Clinical Microbiology, APHP-Hospital R. Debré, Paris, France

    Patricia Mariani-Kurkdjian, Catherine Doit, Edouard Bingen & Stéphane Bonacorsi

  4. Unit of Clinical Epidemiology, APHP-Hospital R. Debré, Paris, France

    Corinne Alberti & Priscilla Armoogum

  5. INSERM, CIE 5, Paris, France

    Corinne Alberti

  6. Department of Pediatrics, APHP-Hospital R. Debré, Paris, France

    Mathie Lorrot, Albert Faye & Antoine Bourrillon

  7. Pediatric Intensive Care, APHP-Hospital R. Debré, Paris, France

    Stéphane Dauger & Mathieu Neve

  8. Division of Emergency Medicine, Department of Medicine, Children’s Hospital Boston, Boston, MA, USA

    Lise E. Nigrovic

  9. Pediatric Emergency Department, Robert Debré University Hospital, 48, Bld Sérurier, 75019, Paris, France

    Luigi Titomanlio

Authors
  1. Fatiha Bargui
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  2. Irene D’Agostino
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  3. Patricia Mariani-Kurkdjian
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  4. Corinne Alberti
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  5. Catherine Doit
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  6. Nathalie Bellier
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  7. Laurence Morin
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  8. Giuliano Galli Gibertini
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  9. Assia Smail
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  10. Anna Zanin
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  11. Mathie Lorrot
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  12. Stéphane Dauger
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  13. Mathieu Neve
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  14. Albert Faye
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  15. Priscilla Armoogum
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  16. Antoine Bourrillon
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  17. Edouard Bingen
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  18. Jean-Christophe Mercier
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  19. Stéphane Bonacorsi
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  20. Lise E. Nigrovic
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  21. Luigi Titomanlio
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Corresponding author

Correspondence to Luigi Titomanlio.

Additional information

Fatiha Bargui and Irene D’Agostino contributed equally.

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Bargui, F., D’Agostino, I., Mariani-Kurkdjian, P. et al. Factors influencing neurological outcome of children with bacterial meningitis at the emergency department. Eur J Pediatr 171, 1365–1371 (2012). https://doi.org/10.1007/s00431-012-1733-5

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  • DOI: https://doi.org/10.1007/s00431-012-1733-5

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