Baraff L J, Lee S I, Schriger D L
UCLA Emergency Medicine Center 90024.
Pediatr Infect Dis J. 1993 May;12(5):389-94. doi: 10.1097/00006454-199305000-00008.
We abstracted the results of all English language reports of the outcomes of bacterial meningitis published after 1955. We used hierarchical Bayesian meta-analysis to determine the overall and organism-specific frequencies of death and persistent neurologic sequelae in children 2 months to 19 years of age. A total of 4920 children with acute bacterial meningitis were included in 45 reports that met the inclusion criteria. Children described in the 19 reports of prospectively enrolled cohorts from developed countries had lower mortality (4.8% vs. 8.1%) and were more likely to have no sequelae (82.5% vs. 73.9%). In these 19 studies 1602 children were evaluated for at least 1 sequela after hospital discharge. The mean probabilities of these sequelae were: deafness, 10.5%; bilateral severe or profound deafness, 5.1%; mental retardation, 4.2%; spasticity and/or paresis, 3.5%; seizure disorder, 4.2%; and no detectable sequelae, 83.6%. Mean probabilities of outcomes varied significantly by etiologic bacteria, e.g. mortality: Haemophilus influenzae, 3.8%; Neisseria meningitis, 7.5%; Streptococcus pneumoniae, 15.3%.
我们汇总了1955年后发表的所有关于细菌性脑膜炎结局的英文报告结果。我们采用分层贝叶斯荟萃分析来确定2个月至19岁儿童死亡及持续性神经后遗症的总体及特定病原体发生率。共有4920例急性细菌性脑膜炎患儿纳入了45篇符合纳入标准的报告。来自发达国家的19篇前瞻性队列研究报告中的患儿死亡率较低（4.8%对8.1%），且更有可能无后遗症（82.5%对73.9%）。在这19项研究中，1602例患儿在出院后至少接受了1种后遗症评估。这些后遗症的平均发生率分别为：耳聋，10.5%；双侧重度或极重度耳聋，5.1%；智力障碍，4.2%；痉挛和/或轻瘫，3.5%；癫痫，4.2%；无明显后遗症，83.6%。结局的平均发生率因病原细菌而异，例如死亡率：流感嗜血杆菌为3.8%；脑膜炎奈瑟菌为7.5%；肺炎链球菌为15.3%。
