Factors associated with fatal outcome in childhood meningococcal disease.

The purpose of this study was to identify factors associated with a fatal outcome in children with meningococcal disease and to design a new clinical scoring system. We reviewed the charts of all 137 children with meningococcal disease admitted alive to the University Hospital, Tromsø, during the years 1977-92. Twelve of the children died (8.7%). On admission the following clinical signs were significantly associated with poor outcome: peripheral vasoconstriction, cyanosis, extensive petechiae, hypotension, altered consciousness, hyperventilation and absence of neck rigidity. The laboratory parameters low pH, low base excess, thrombocytopenia, low Trombotest and leukopenia were also associated with later death. Multiple logistic regression was performed to examine the independent effect of each variable. Cyanosis, peripheral vasoconstriction and base excess < -10 mmol/l or pH < 7.35 were significantly associated with a fatal outcome. A clinical scoring system based on the extent of petechiae, the presence of peripheral vasoconstriction, hyperventilation and/or cyanosis, the absence of neck rigidity and impairment of consciousness is proposed. Twenty-nine patients received > or = 3.5 points, of whom 12 died and 12 survived. None of the patients who died had less than 3.5 points. The clinical scoring system is based solely on clinical signs. It can be done rapidly and performs well in identifying children who might benefit from early intensive care.