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Long-term skin scarring and orthopaedic sequelae in survivors of meningococcal septic shock
  1. Corinne Buysse (c.buysse{at}erasmusmc.nl)
  1. Erasmus MC-Sophia, Netherlands
    1. Arnold P Oranje
    1. Erasmus MC-Sophia, Netherlands
      1. Esther Zuidema
      1. Erasmus MC-Sophia, Netherlands
        1. Jan A Hazelzet
        1. Erasmus MC-Sophia, Netherlands
          1. Wim Hop
          1. Erasmus MC-Sophia, Netherlands
            1. A Diepstraten
            1. Erasmus MC-Sophia, Netherlands
              1. Koen Joosten
              1. Erasmus MC-Sophia, Netherlands

                Abstract

                Objective: to assess the incidence of skin scarring and orthopaedic sequelae (amputation, limb-length discrepancy) in patients who survived meningococcal septic shock (MSS) in childhood and to determine the severity and predictors of these sequelae.

                Design and Patients: all 179 consecutive patients (170 were eligible) with septic shock and purpura requiring intensive care treatment between 1988 and 2001 in Rotterdam, the Netherlands. Patients were invited 4-16 years after PICU discharge for a visit to the follow-up clinic.

                Results: of the 120 follow-up patients (follow-up interval 10 years; age at follow-up 14.5 years(all medians)), 58 patients (48%) had skin scarring due to purpura. This varied from barely visible scars to extremely disfiguring scars. Ten patients (8%) had to undergo amputation(s) of extremities, ranging from 1 toe to both legs and 1 arm. Seven patients (6%) had lower limb-length discrepancy, in most cases together with angular deformity, requiring 1 or more late surgical intervention(s). Patients with scars or orthopaedic sequelae had significantly higher severity of illness scores, determined by Pediatric Risk of Mortality Score, Vasopressor score and Disseminated Intravascular Coagulation score. Gender or Neisseria meningitidis serogroup had no significant influence on the presence of scars or orthopaedic sequelae. Patients with lower limb-length discrepancy were significantly younger at the time of PICU admission.

                Conclusions: the incidence of long-term skin scarring and orthopaedic sequelae was high (resp. 48% and 14%) in patients who survived MSS in childhood. Severity of these sequelae varied from mild to severe. Patients with scars or orthopaedic sequelae had significantly higher severity of illness scores.

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