Factores pronósticos en meningitis bacteriana aguda en niños: estudio caso-control / Prognostic factors in acute bacterial meningitis in children: a case control study

RESUMO

Background: The prognosis of acute bacterial meningitis continues to be poor in our country. Previous studies suggest that the delay in diagnosis has an important prognostic value. Aim: To study the influence of diagnosis timing and the clinical conditions of children with acute bacterial meningitis on admission on death and incidence of gross sequelae. Patients and methods: Charts of children deceased or discharged with gross sequelae as consequence of an acute bacterial meningitis were selected. To each of these cases, 4 children with the same diagnosis but discharged in good conditions were selected as controls. Variables recorded were time and number of visits previous to the diagnosis, etiology of meningitis, neurological, respiratory, digestive and hemodynamic involvement on admission. Results: Fifty seven cases and 224 controls were studied. Most cases were 12 months old or less (OR 4.1, 95 percent CI= 1.97-8.7). Diagnosis made on the first visit or within the first 24 hours of disease, improved prognosis (OR 0.25, 95 percent CI= 0.07-0.78). An age of less than 12 months and a diagnosis made after more than 12 hours of disease or after more than one consultation interacted multiplying their effect on a dismal prognosis. Coma on admission (OR 7 95 percent CI=3-14.3) and S Pneumoniae etiology (OR 7, CI 95 percent= 3.4, 14.3) were also associated with a bad prognosis. Conclusions: Early diagnosis of acute bacterial meningitis is protective for death or gross sequelae at discharge. Age, coma and S Pneumoniae etiology are the main factors associated with a poor prognosis