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Editor,—Pollard et algive an excellent review of the emergency management of meningococcal disease.1 We strongly support the involvement of the paediatric intensive care unit (PICU) at an early stage; however, only a third of all admissions with meningococcal disease are admitted to a PICU. Deciding which children need PICU admission can be a major clinical challenge. It would be inappropriate to transfer all children—they would occupy beds better used for other patients. Although the algorithm in fig 1 of Pollard et al’s article is useful in assessing children who may need PICU admission, it does not cover most children seen in district hospitals who have milder disease. We were disappointed that no mention was made of the role of severity scores, especially the Glasgow meningococcal septicaemia prognostic score (GMSPS)2; which has been validated retrospectively …