Prognostic accuracy of five simple scales in childhood bacterial meningitis

Abstract

Background: In childhood acute bacterial meningitis, the level of consciousness, measured with the Glasgow coma scale (GCS) or the Blantyre coma scale (BCS), is the most important predictor of outcome. The Herson–Todd scale (HTS) was developed for Haemophilus influenzae meningitis. Our objective was to identify prognostic factors, to form a simple scale, and to compare the predictive accuracy of these scales. Methods: Seven hundred and twenty-three children with bacterial meningitis in Luanda were scored by GCS, BCS, and HTS. The simple Luanda scale (SLS), based on our entire database, comprised domestic electricity, days of illness, convulsions, consciousness, and dyspnoea at presentation. The Bayesian Luanda scale (BLS) added blood glucose concentration. The accuracy of the 5 scales was determined for 491 children without an underlying condition, against the outcomes of death, severe neurological sequelae or death, or a poor outcome (severe neurological sequelae, death, or deafness), at hospital discharge. Results: The highest accuracy was achieved with the BLS, whose area under the curve (AUC) for death was 0.83, for severe neurological sequelae or death was 0.84, and for poor outcome was 0.82. Overall, the AUCs for SLS were ≥0.79, for GCS were ≥0.76, for BCS were ≥0.74, and for HTS were ≥0.68. Conclusions: Adding laboratory parameters to a simple scoring system, such as the SLS, improves the prognostic accuracy only little in bacterial meningitis.

Keywords::

• Risk factors
• outcome
• child
• meningitis
• developing countries

Acknowledgements

The authors thank Elizabete Anjos, Marlene Pardal, and Afonso Sozinho, who performed most of the diagnostic laboratory tests in Luanda. The study was supported by the Päivikki and Sakari Sohlberg Foundation, Sigrid Jusélius Foundation, the Foundation for Paediatric Research, and the daily newspaper Helsingin Sanomat, Helsinki, Finland.

Declaration of interest: HP serves the Serum Institute of India as a clinical scientific consultant. All other authors have no potential conflicts of interest to be disclosed.