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Department of
Paediatrics, Imperial College School of Medicine, St Mary's Hospital,
Norfolk Place, London W2 1PG, UK
Correspondence to: Prof. Levin m.levin{at}ic.ac.uk
Accepted 24 July 2001
BACKGROUND AND AIMS
The case
fatality rate from meningococcal disease (MD) has remained relatively
unchanged in the post antibiotic era, with 20-50% of patients who
develop shock still dying. In 1992 a new paediatric intensive care unit
(PICU) specialising in MD was opened. Educational information was
disseminated to local hospitals, and a specialist transport service was
established which delivered mobile intensive care. The influence of
these changes on mortality of children with MD was investigated.
METHODSA total of 331 consecutive
children with meningococcal disease admitted to the PICU between 1992 and 1997 were studied. Severity of the disease on admission was
assessed using the paediatric risk of mortality (PRISM) score. Logistic
regression analysis was used to correct for clinical severity, age, and
sex; death was the outcome, and year of admission, a temporal trend
variable, was the primary exposure.
RESULTSThe case fatality rate fell
year on year (from 23% in 1992/93 to 2% in 1997) despite disease
severity remaining largely unchanged. After adjustment for age, sex,
and disease severity, the overall estimate for improvement in the odds
of death was 59% per year (odds ratio for the yearly trend 0.41).
CONCLUSIONSA significant
improvement in outcome for children admitted with MD to a PICU has
occurred in association with improvements in initial management of
patients with MD at referring hospitals, use of a mobile intensive care
service, and centralisation of care in a specialist unit.
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