Intensive Care Medicine

, Volume 28, Issue 3, pp 341–351 | Cite as

A new prognostic scoring system for meningococcal septic shock in children. Comparison with three other scoring systems

  • Álvaro Castellanos-Ortega
  • Miguel Delgado-Rodríguez
  • Javier Llorca
  • Pilar Sánchez Burón
  • Santiago Mencía Bartolomé
  • Juan Soult Rubio
  • Guillermo Milano Manso
  • Pedro Domínguez Sampedro
  • Ramiro Blanco Montero
  • Antonio Rodríguez Núñez
  • Elisa  Zambrano Pérez
  • Corsino Rey Galán
  • Nuria López Negueruela
  • Roberto Reig Sáenz
Neonatal and Pediatric Intensive Care

Abstract.

Objective: To develop a quick and sensitive method for identification of children with presumed meningococcal septic shock at risk of death at admission to the pediatric intensive care unit (PICU) and to compare its performance with three other prognostic systems: Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS), Malley score and the Paediatric Index of Mortality (PIM). Design: Multicenter retrospective cohort study. Setting: PICUs of 14 tertiary hospitals. Patients: The developmental sample included 192 children consecutively admitted to the PICUs with presumed or confirmed meningococcal septic shock from 1983 to 1995. The validation sample included 158 children consecutively admitted from 1996 to 1998. Interventions: Clinical and laboratory data gathered during the first 2 h after admission were used to develop the new score and to compute the other scoring systems. Logistic regression was applied to identify the independent predictors of death. Measurements and results: Overall mortality was 31.5%. The new score included seven variables: cyanosis (2 points), Glasgow coma scale less than 8 (2 points), refractory hypotension (2 points), oliguria (1 point), leukocytes less than 4000/mm3 (1 point), partial thromboplastin time more than 150% of control value (1 point) and base deficit more than 10 mmol/l (1 point). The new score provided the best discriminative capability, as measured by the area under the ROC curve (SEM) in the validation sample =0.88 (0.03), PIM =0.82 (0.04), Malley I =0.80 (0.04), GMSPS =0.79 (0.04) and Malley II =0.76 (0.04). Conclusions: A new prognostic score is proposed for therapeutic stratification of children with presumed meningococcal septic shock.

Pediatrics Neisseria meningitidis Septic shock Severity of illness index Pediatric intensive care units Prognosis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Álvaro Castellanos-Ortega
    • 1
  • Miguel Delgado-Rodríguez
    • 2
  • Javier Llorca
    • 2
  • Pilar Sánchez Burón
    • 4
  • Santiago Mencía Bartolomé
    • 5
  • Juan Soult Rubio
    • 6
  • Guillermo Milano Manso
    • 7
  • Pedro Domínguez Sampedro
    • 8
  • Ramiro Blanco Montero
    • 9
  • Antonio Rodríguez Núñez
    • 10
  • Elisa  Zambrano Pérez
    • 11
  • Corsino Rey Galán
    • 12
  • Nuria López Negueruela
    • 13
  • Roberto Reig Sáenz
    • 14
  1. 1.Department of Intensive Care Medicine, Pediatric Intensive Care Unit, Residencia Cantabria (Hospital Universitario Marqués de Valdecilla), Avenida Cazoña s/n, 39011 Santander, SpainSpain
  2. 2.Division of Preventive Medicine and Public Health, University of Cantabria, Avenida Cardenal Herrera Oria s/n, 39011 Santander, SpainSpain
  3. 3.Division of Preventive Medicine and Public Health, University of Jaen, edificio B-3, 23071 Jaen, SpainSpain
  4. 4.Equipo de Atención Primaria Ángela Uriarte, Candilejas 66, 28018 Madrid, SpainSpain
  5. 5.Pediatric Intensive Care Unit, Hospital Niño Jesús, Universidad Autónoma, Avenida Menéndez Pelayo 65, 28009 Madrid, SpainSpain
  6. 6.Pediatric Intensive Care Unit, University Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Sevilla, SpainSpain
  7. 7.Department of Pediatrics, Pediatric Intensive Care Unit, Hospital Carlos Haya, Avenida Arroyo de los ángeles s/n, 29011 Málaga, SpainSpain
  8. 8.Pediatric Intensive Care Unit, University Hospital Vall D'Ebrón, Paseo Vall D'Ebrón 119–129, 0835 Barcelona, SpainSpain
  9. 9.Pediatric Intensive Care Unit, Hospital Juan Canalejo, Xubias de Arriba 84, 15006 La Coruña, SpainSpain
  10. 10.Department of Pediatric Emergency and Critical Care, Hospital Xeral de Galicia, Galeras s/n, 15705 Santiago de Compostela, SpainSpain
  11. 11.Pediatric Intensive Care Unit, University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, SpainSpain
  12. 12.Pediatric Intensive Care Unit, Hospital Central de Asturias, Celestino Villamiel s/n, 33006 Oviedo, SpainSpain
  13. 13.Pediatric Intensive Care Unit, Hospital Infantil La Paz, Universidad Autónoma, Paseo de la Castellana 261, 28046 Madrid, SpainSpain
  14. 14.Pediatric Intensive Care Unit, General Hospital of Alicante, Avenida Albufereta 81, 03016 Alicante, SpainSpain

Personalised recommendations