Arch Dis Child 2001;85:386-390 ( November )

Article

Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery R Booy, P Habibi, S Nadel, C de Munter, J Britto, A Morrison, M Levin, the Meningococcal Research Group

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 AIMSThe 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.


Keywords: meningococcal disease; survival; intensive care

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© 2001 by Archives of Disease in Childhood
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