Pelkonen Tuula, Roine Irmeli, Monteiro Lurdes, Cruzeiro Manuel Leite, Pitkäranta Anne, Kataja Matti, Peltola Heikki
Hospital Pediátrico David Bernardino, Luanda, Angola.
Scand J Infect Dis. 2012 Aug;44(8):557-65. doi: 10.3109/00365548.2011.652666. Epub 2012 Jan 31.
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.
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.
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.
Adding laboratory parameters to a simple scoring system, such as the SLS, improves the prognostic accuracy only little in bacterial meningitis.
在儿童急性细菌性脑膜炎中，用格拉斯哥昏迷量表（GCS）或布兰太尔昏迷量表（BCS）测量的意识水平是预后的最重要预测指标。赫森 - 托德量表（HTS）是针对流感嗜血杆菌脑膜炎开发的。我们的目的是确定预后因素，形成一个简单的量表，并比较这些量表的预测准确性。
对罗安达的723例细菌性脑膜炎患儿进行GCS、BCS和HTS评分。基于我们的整个数据库的简单罗安达量表（SLS）包括家庭用电情况、患病天数、惊厥、意识以及就诊时的呼吸困难情况。贝叶斯罗安达量表（BLS）增加了血糖浓度。针对491例无基础疾病的患儿，根据出院时的死亡、严重神经后遗症或死亡情况，或不良结局（严重神经后遗症、死亡或耳聋），确定这5种量表的准确性。
BLS的准确性最高，其死亡曲线下面积（AUC）为0.83，严重神经后遗症或死亡的AUC为0.84，不良结局的AUC为0.82。总体而言，SLS的AUC≥0.79，GCS的AUC≥0.76，BCS的AUC≥0.74，HTS的AUC≥0.68。
在简单评分系统（如SLS）中添加实验室参数，在细菌性脑膜炎中对预后准确性的提高甚微。
