Feb 21, 2018 - Al-Nasser Paediatric Hospital: a retrospective cohort study. Nabil Al-Barqouni, Awni Al Shorafa, Belal Dabour, Sherin Abed, Loai Albarqouni.
Abstracts
Management of acute meningococcal septicaemia in Al-Nasser Paediatric Hospital: a retrospective cohort study Nabil Al-Barqouni, Awni Al Shorafa, Belal Dabour, Sherin Abed, Loai Albarqouni
Abstract
Background Acute meningococcal septicaemia is a fulminant disease, and mortality and long-term morbidity can be very high if not treated appropriately. We aimed to evaluate case fatality rate of all children admitted with acute meningococcal septicaemia. Methods We did a retrospective cohort study of all paediatric cases of acute meningococcal septicaemia admitted to Al-Nasser Paediatric Hospital, the largest paediatric hospital in the Gaza Strip. Acute meningococcal septicaemia was diagnosed clinically and confirmed on the basis of results from skin smears and blood cultures, and meningitis was diagnosed clinically and confirmed by bacteriological examination of cerebrospinal fluid. Sociodemographic and clinical data and outcome information were obtained from hospital records. Outcome measures were predicted mortality using Paediatric Risk of Mortality score III (PRISM-III), actual mortality, and standardised mortality ratio (SMR). Findings Between Jan 1, 2009, and Sept 31, 2015, 240 children were admitted with acute meningococcal septicaemia. 113 (47%) children were boys, and the average age was 3·15 years (SD 2·6). The number of admitted children with acute meningococcal septicaemia decreased from 47–59 cases per year in 2009–11, to 21–22 cases per year in 2012–15. Similarly, there were fewer deaths in 2012–15 (n=14) than in 2009–11 (n=35). The total mortality predicted by PRISMIII was 25·6%, whereas the actual overall mortality was 21% (standardised mortality ratio 0·814; n=49). 41 (82%) children died within 24 h of admission, 69 (29%) children received corticosteroid, 85 (35%) children received inotropic medications, and 46 (19%) children required mechanical ventilation for a median of 24 h (IQR 6–48]. Acute meningococcal septicaemia was associated with meningitis in 75 (31%) children. The most common complications were multiorgan failure (22 [9%] children), skin necrosis or scarring (13 [5%]), convulsions or seizures (13 [5%]), and disseminated intravascular coagulopathy (ten [4%]). Mortality was independently associated with age (odds ratio per 1-year decreased age 1·06, 95% CI 1·03–1·10; p=0·0006), shock (3·83, 1·32–11·70; p=0·015), absence of meningitis on presentation (9·55, 3·25–28·07; p=0·0013), and mechanical ventilation (9·85; 4·31–22·54; p
