Skip to main content

Advertisement

Table 3 Study characteristics of studies on prediction of sequelae after bacterial meningitis.

From: Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies

Study Score (quality) Design Developed or developing (Country) N Age at infection Pathogen Follow-up duration Outcome: Analysis Significant prognostic factors
From multivariate analysis
Or from univariate analysis with p < 0.05
Forsyth et al., 2004 [18] 53 (+/-) Prospective Developing (Malawi) 343 2 months - 13 yr All 1 and 6 months after discharge Hearing loss Univariate Coma, positive CSF Gram stain, a low peripheral WBC count, high CSF protein level, associated neurological sequelae
Koomen et al., 2003 [7] 50 (+/-) Retrospective Developed (The Netherlands) 628 0 - 9.5 yr (mean 2.4yr) Non Hib   Hearing loss Multivariate History of symptoms >2 days, absence petechiae, low CSF glucose level, causative pathogen (S. pneumoniae), ataxia
Woolley et al., 1999 [9] 49,5 (+/-) Retrospective Developed (UK) 432 Median 7.7 months All 6 months intervals for at least 1 yr (range 1-5 yr) Hearing loss Multivariate Male sex, increased ICP, low CSF glucose level, causative pathogen (S. pneumoniae), presence nuchal rigidity
Kutz et al., 2006 [14] 43,5 (-) Retrospective Developed (USA) 171 3 months 17 yr (mean 3.8 yr) All During hospitalization (longer if necessary) Hearing loss Univariate Long duration hospitalization, cranial nerve neuropathy, low CSF glucose level, high CSF protein level,
seizures (not significant in case of S. pneumoniae)
Lovera et al., 2005 [33] 56 (+/-) Retrospective Developing (Paraguay) 72 35 days - 15 yr (mean 48 months) S. pneumoniae During hospitalization Mortality Univariate Age <12 months, coma, seizures, prolonged duration of seizures >48 h, low CSF WBC count, high CSF protein (albumin) level, low CSF glucose level, low peripheral WBC count, low Hb
Roine et al., 2008 [35] 55 (+/-) Prospective Developing (6 countries in Latin America) 654 total cohort, 332 included in analysis Median 8 months in patients who died, median 12 months in survivors (not otherwise reported) all During hospitalization Mortality Multivariate Impaired consciousness, poor peripheral circulation, high CSF protein level
Pelkonen et al., 2009 [6] 54,5 (+/-) Retrospective Developing (Angola) 403 total cohort, 290 included in analysis Median 9.0 months All During hospitalization Mortality Multivariate Impaired consciousness, severe dyspnea, convulsions during hospitalization
Kornelisse et al., 1995 [8] 48 (+/-) Retrospective Developed (The Netherlands) 83 3 days- 12.3 yr (median 8 months) S. pneumoniae During hospitalization Mortality Univariate Comatose level of consciousness, shock, respiratory distress, low peripheral WBC count, low serum sodium level, high CSF protein level
Fakhir et al., 1992 [27] 47 (+/-) Retrospective Developing (India) 247 1 month - 14 yr N. meningitidis During hospitalization Mortality Univariate Illness duration <12 h, hypotension, peripheral circulatory failure, coma (disturbed sensorium), rash duration <12 h, rash extent widespread, fever >40°C, absent neck rigidity, low peripheral WBC count, low ESR, low platelet count
Akpede et al., 1999 [16] 45,5 (+/-) Prospective Developing (Nigeria) 109 >1 month - 15 yr All During hospitalization (after discharge?) Mortality Univariate Seizures, coma, shock
Wasier et al., 2005 [37] 40,5 (-) Retrospective Developed (France) 49 1 - 108 months (median 17 months) S. pneumoniae 1-12 yr (mean 5 yr) Mortality Multivariate High PRISM II score, low peripheral WBC count, low platelet count
Chao et al., 2008 [26] 32 (-) Retrospective Developing (Taiwan) 37 3 months - 11 yr (mean 37 months) S. pneumoniae   Mortality Univariate Coma, shock, mechanical ventilation (endotracheal tube intubation), hyponatremia, low CSF WBC count, low CSF glucose level, low CSF/blood glucose ratio
Johnson et al., 2007 [28] 32 (-) Retrospective Developing (Nigeria) 71 <16 yr All During hospitalization Mortality Univariate Respiratory distress, purulent/turbid CSF appearance, high CSF protein level, low CSF glucose level
Bortolussi et al., 1978 [25] 30,5 (-) Retrospective Developed (Canada) 52 Neonates (<1 month) All During hospitalization Mortality Univariate low peripheral WBC count, thrombocytopenia, low birth weight <2500 g
Study Score (quality) Design Developed or developing (Country) N Age at infection Pathogen Follow-up duration Outcome: sequelae Analysis Significant prognostic factors
From multivariate analysis
Or from univariate analysis with p < 0.05
Koomen et al., 2004 [5] 62,5 (+) Retrospective Developed (The Netherlands) 182 0 - 9.5 yr
(mean 2.4yr)
Non- Hib 4.0 - 10.4 yr post meningitis (average 7.4 yr) Neurological sequelae
Academic & behavioural limitations
Multivariate male gender, low birth weight ≤3000 g, low educational level father, causative pathogen (S. pneumoniae), low CSF WBC count, delay >6 h start antibiotics, dexamethasone use ≤2 days, anticonvulsive treatment of seizures, prolonged fever >9 days
Pelkonen et al., 2009 [6] 54,5 (+/-) Retrospective Developing (Angola) 403 total cohort, 249 survivors, 200 included in analysys Median 9.0 months All During hospitalization Severe neurological sequelae Multivariate History of symptoms >3 days, impaired consciousness, convulsions during hospitalization
Biesheuvel et al., 2006 [24] 52 (+/-) Retrospective Developed (The Netherlands) 88 (derivation)
628 (validation)
0.9 - 5.8 yr (mean 2.8 yr) (derivation) and 0 - 9.5 yr (mean 1.9 yr) (validation) Non Hib   Neurological sequelae
Both mild and severe
Multivariate Seizures (atypical convulsions), absence petechiae/ecchymoses, low body temperature <40°C, high body temperature/fever >40°, causative pathogen (S. pneumoniae), use of anti epileptic drugs >2 days
Singhi et al., 2007 [15] 48,5 (+/-) Prospective Developing (India) 80 2 months - 12 yr (mean 31.4 months) All 12-44 months after discharge (mean 27.5 months) Neurological sequelae
Both mild and severe
Multivariate coma, cranial nerve palsy, absent deep tendon reflexes
Kornelisse et al., 1995 [8] 48 (+/-) Retrospective Developed (The Netherlands) 83 3 days- 12.3 yr (median 8 months) S. pneumoniae Hospital duration Neurological sequelae
Both mild and severe
Univariate High clinical severity score (Herson & Todd score), vomiting, shock, low peripheral WBC count, low CSF WBC count, low CSF glucose level
Akpede et al., 1999 [16] 45,5 (+/-) Prospective Developing (Nigeria) 109 >1 month - 15 yr All During hospitalization (after discharge?) Neurological sequelae
Both mild and severe motor and sensory sequelae
Univariate Young age ≤2 yr, seizures, coma, prolonged fever >7 days, antibiotic treatment, focal nerve deficits, abnormal posturing, abnormal muscle tone
Pikis et al., 1996 [20] 43,5 (-) Retrospective Developed (Greece) 47 1 month - 14 yr (mean 2.6 yr) S. pneumoniae 4- 23 yr (mean 12.4 yr) Neurologic sequelae
Both mild and severe
Multivariate Coma, high peripheral WBC count
Pomeroy et al., 1990 [34] 42,5 (-) Prospective Developed (USA) 185 1 month - 14 yr (median 10 months) All 1,3,6,12, months after discharge and yearly up to 6 yr Neurologic sequelae
Both mild and severe
Univariate Seizures, low CSF glucose level
Chao et al., 2008 [26] 32 (-) Retrospective Developing (Taiwan) 37 3 months - 11 yr (mean 37 months) S. pneumoniae   Neurological sequelae
Both mild and severe lasting >6 months
Univariate Focal neurological signs, seizures
Study Score (quality) Design Developed or developing (Country) N Age at infection Pathogen Follow-up duration Outcome: poor outcome Analysis Significant prognostic factors
From multivariate analysis
Or from univariate analysis with p < 0.05
Lovera et al., 2005 [33] 56 (+/-) Retrospective Developing (Paraguay) 72 35 days - 15 yr (mean 48 months) S. pneumoniae During hospitalization Mortality & neurological sequelae Univariate Young age <12 months, coma, seizures, seizure duration >48 h, low CSF WBC count, high CSF protein (albumin) level, low CSF glucose level, low peripheral WBC count, low Hemoglobin
Oostenbrink et al., 2002 [21] 55 (+/-) Retrospective Developed (The Netherlands) 93 1 month - 15 yr (median 2.8 yr) Non Hib 0.6 yr Mortality & neurological sequelae Multivariate male gender, seizures (atypical convulsions), low body temperature, causative pathogen (S. pneumoniae)
Roine et al., 2008 [35] 55 (+/-) Prospective Developing (6 countries in Latin America) 642 total cohort, 356 included in analysis Median 7 months in patients whith positive outcome measure died, median 14 months in patients without (not otherwise reported) all During hospitalization Mortality & severe neurological sequelae Multivariate Impaired consciousness, history of symptoms >48 h, high CSF protein level, low peripheral WBC count
Roine et al., 2008 [35] 55 (+/-) Prospective Developing (6 countries in Latin America) 641 total cohort, 296 included in analysis Median 7 months in patients whith positive outcome measure died, median 18 months in patients without (not otherwise reported) all During hospitalization Mortality & all neurological sequelae Multivariate Impaired consciousness, convulsions before admission, poor peripheral circulation, low CSF glucose level, low peripheral WBC count
Pagliano et al., 2007 [19] 52 (+/-) Prospective Developed (Italy) 64 1 month -14 yr (median 26 months) S. pneumoniae 8 weeks Mortality & neurological sequelae Multivariate ICU admission, low CSF WBC count, penicillin nonsusceptibility
Klinger et al., 2000 [31] 48,5 (+/-) Retrospective Developed (Canada) 101 Neonates 1-28 days All 1 yr Mortality & neurological sequelae Univariate Hypotension, coma, inotrope, seizure duration >12 h, status epilepticus, low CSF/blood glucose level, low peripheral WBC count, abnormal neurological examination at discharge, ventilation, no. of anticonvulsants
Klinger et al., 2000 [31] 48,5 (+/-) Retrospective Developed (Canada) 101 Neonates 1-28 days All 1 yr
During hospitalization,
Mortality & neurological sequelae *multivariate analysis * For different time schedules during and after hospital admission not presented here
Akpede et al., 1999 [16] 45,5 (+/-) Prospective Developing (Nigeria) 109 >1 month - 15 yr All Possibly after discharge in neurologic clinic Mortality & neurological sequelae Univariate Young age ≤2 yr, seizures, coma, shock, prolonged fever, >7 days antibiotic treatment, no meningeal signs, focal nerve deficits, abnormal posturing, abnormal muscle tone
Kaaresen et al., 1995 [29] 43,5 (-) Retrospective Developed (Norway) 92 Median 1.9 yr
(range 1 month - 13.8 yr)
All Hospital duration and mean 6 weeks afterwards, or longer if necessary Mortality & neurological sequelae Multivariate History of symptoms >48 h, seizures, high body temperature,>38 °C, peripheral vasoconstriction, low CSF WBC count
Grimwood et al., 1996 [12] 40 (-) Prospective Developed (Australia) 138 3 months - 14 yr All Mean 6.7 yr post meningitis (range 5.3-9.3 yr) Mortality & neurological sequelae Multivariate Young age ≤12 months, long symptom duration before diagnosis >24 h, seizures >72 h, focal neurological signs
Edwards et al., 1985 [17] 38 (-) Retrospective Developed (USA) 51 Infants (not further described) Group B streptococcus Mean 6 yr (range 3.3- 9.0 yr Mortality & neurological sequelae Univariate Coma, hypotension (BP <40 mm Hg), low peripheral WBC count, low PMN, high CSF protein level
Letson et al., 1992 [32] 38 (-) Retrospective Developed (USA) 53 3.5 weeks - 30 months (mean 8 months H. influenzae b
S. pneumoniae
Mean 35 months Mortality & neurological sequelae Multivariate Seizures, male gender, low CSF glucose level
Anttila et al., 1994 [22] 27,5 (-) Prospective Developed (Finland) 143 Mean 30 months range 3 months - 15 yr All During hospitalization, at discharge and at 2 weeks, 3,6,12 months Mortality & neurological sequelae Univariate Low body temperature, coma, neck rigidity, leaving supine position
Kirimi et al., 2003 [30] 27,5 (-) Prospective Developing
(Turkey)
48 2 months - 13 yr all Hospital duration Mortality & neurological sequelae Univariate Fever >36-48 h after admission, coma 6-48 h after admission, anaemia, prolonged anaemia >3 days, low CSF WBC count, high CRP level, high CSF WBC count >3 days, low CRP level >3 days, antibiotic treatment
Valmari et al., 1987 [36] 24,5 (-) Retrospective Developed (Finland) 123 developing model
98 validation model
1 month- 14 yr
mean 30 months developing model
mean 20 months validation model
all Mean 2 months Mortality & neurological sequelae Multivariate Male sex, low CSF glucose level, low CSF WBC count, otitis media, low Hb, low serum potassium level, positive CSF gram stain, focal neurological signs, low peripheral WBC count, low CSF granulocyte %, low platelet count, neck rigidity, absence petechiae, duration of symptoms >48 h
Herson et al., 1977 [13] 19,5 (-) Retrospective Developed (USA) 73 6 weeks - 5 yr H. influenzae b Hospital duration,
Residual morbidity: 3 months - 2 yr
Mortality & neurological sequelae Univariate Coma, low body temperature, seizures, shock (BP <60 mm Hg), young age <12 months, low CSF WBC count, low Hb, low CSF glucose level, prolonged symptom duration
Bhat et al., 1987 [23] 17 (-) Prospective Developing (India) 256 Non neonatal (not further described) all   Mortality & neurological sequelae Univariate Duration of illness prior to therapy >7 days, low body temperature, coma, associated illness, low peripheral WBC count, purulent/turbid CSF appearance, high CSF WBC count, high CSF protein level, low CSF glucose level, neck rigidity, distension of abdomen, no meningeal signs, positive gram stain, positive culture, type of causative pathogen
  1. Studies are grouped by outcome categories and ranked by quality.