RESUMEN
We performed a cohort study of children who survived bacterial meningitis after the neonatal period at a single pediatric center in France over a 10-year period (1995-2004) to identify predictors of death and long-term neurological deficits in children with bacterial meningitis. We performed multivariate regression to determine independent predictors of death and neurologic deficits. We identified 101 children with bacterial meningitis of which 19 died during initial hospitalization. Need for mechanical ventilation [hazard ratio (HR) 11.5, 95 % confidence interval (CI) 2.4-55.5)] and thrombocytopenia defined as a platelet count <150 × 10(9) per liter (HR 0.6, 95 % CI 0.4-0.9) at presentation were associated with death during initial hospitalization. At final assessment, 42 of the 70 survivors had no neurologic deficits identified; 20 had a single deficit, and eight had multiple deficits. A delay in initiation of antibiotics (HR 1.3, 95 % CI 1.1-1.7) and hydrocephalus on computed tomographic scan (HR 2.6, 95 % CI 1.1-6.0) were associated with having one or more long-term neurologic deficits. Identification of children at risk of death or long-term neurologic sequelae may allow therapeutic interventions to be directed to children at the highest risk.
Asunto(s)
Meningitis Bacterianas/complicaciones , Trastornos Mentales/etiología , Enfermedades del Sistema Nervioso/etiología , Estudios de Cohortes , Epilepsia/etiología , Femenino , Estudios de Seguimiento , Pérdida Auditiva Sensorineural/etiología , Mortalidad Hospitalaria , Hospitalización , Humanos , Lactante , Discapacidad Intelectual/etiología , Masculino , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/mortalidad , Meningitis Bacterianas/terapia , Trastornos Migrañosos/etiología , Trastornos del Movimiento/etiología , Análisis Multivariante , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Trastornos del Sueño-Vigilia/etiología , Resultado del TratamientoAsunto(s)
Cefalea/diagnóstico , Convulsiones/diagnóstico , Vómitos/diagnóstico , Anticonvulsivantes/uso terapéutico , Niño , Diagnóstico Diferencial , Diazepam/uso terapéutico , Electroencefalografía , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Migraña con Aura/complicaciones , Mioclonía/complicaciones , Convulsiones/etiología , Síndrome , Tomografía Computarizada por Rayos X , Vómitos/etiologíaRESUMEN
Despite the typically benign nature of febrile seizures, a large number of children with simple febrile seizures are overinvestigated and overtreated, according to the personal clinical experience of the treating doctors. The study objective was to analyze the effect of implementing an evidence-based medicine guideline on the management of febrile seizures in two European pediatric emergency departments. After introduction of a selected guideline, we analyzed the change in hospitalization rate and in the rate of execution of blood exams in children presenting with febrile seizures. Included in the study were 483 children. Clinical characteristics of seizures were similar both before and after implementation. Clinical management was modified after guideline introduction, because the hospitalization rate significantly decreased (respectively, from 57.3% to 20.5%, and from 16.9% to 3.2%), without any concomitant increase in readmission rate. Readmission cases were never due to severe bacterial infections. The proportion of patients who received blood examinations decreased significantly. We conclude that in both of the Emergency Departments studied, introduction of a guideline on febrile seizure positively modified clinical management. The availability of a guideline contributed to accelerating the process of improving welfare and positively influenced the quality of care.
