Valtiala Ester, Roine Irmeli, Cruzeiro Manuel Leite, Peltola Heikki, Pelkonen Tuula
Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Faculty of Medicine, University Diego Portales, Santiago, Chile.
Acta Paediatr. 2024 Jul;113(7):1644-1652. doi: 10.1111/apa.17217. Epub 2024 Mar 21.
A low Glasgow Coma Scale Score (GCS) on admission is a known predictor of poor outcome from childhood bacterial meningitis. In turn, the factors associated with the admission GCS are less known. Our aim was to identify them, both for clinical alerts of reserved prognosis and to find potential targets for intervention.
This study is a secondary analysis of data collected prospectively in Angola and in Latin America between 1996 and 2007. Children with bacterial meningitis were examined on hospital admission and their GCS was assessed using the age-adjusted scale. Associations between on-admission GCS and host clinical factors were examined.
A total of 1376 patients with confirmed bacterial meningitis were included in the analysis (609 from Latin America and 767 from Angola). The median GCS was 13 for all patients (12 in Angola and 13 in Latin America). In the multivariate analysis, in the areas combined, seizures, focal neurological signs, and pneumococcal aetiology associated with GCS <13, as did treatment delay in Latin America.
Besides pneumococcal aetiology, we identified characteristics, easily registrable on admission, which are associated with a low GCS in childhood bacterial meningitis. Of these, expanding pneumococcal vaccinations and treatment delays could be modified.
入院时格拉斯哥昏迷量表（GCS）评分低是儿童细菌性脑膜炎预后不良的已知预测指标。反过来，与入院时GCS相关的因素则鲜为人知。我们的目的是识别这些因素，既用于预后不佳的临床警示，也用于寻找潜在的干预靶点。
本研究是对1996年至2007年间在安哥拉和拉丁美洲前瞻性收集的数据进行的二次分析。对细菌性脑膜炎患儿在入院时进行检查，并使用年龄校正量表评估其GCS。研究入院时GCS与宿主临床因素之间的关联。
共有1376例确诊细菌性脑膜炎患者纳入分析（609例来自拉丁美洲，767例来自安哥拉）。所有患者的GCS中位数为13（安哥拉为12，拉丁美洲为13）。在多变量分析中，在合并区域，癫痫发作、局灶性神经体征和肺炎球菌病因与GCS<13相关，拉丁美洲的治疗延迟也与之相关。
除了肺炎球菌病因外，我们还识别出了入院时易于记录的、与儿童细菌性脑膜炎低GCS相关的特征。其中，扩大肺炎球菌疫苗接种和治疗延迟是可以改变的。
