Improved outlook for meningococcaemia

About two years ago we published a paper from the paediatric intensive care unit at St Mary's Hospital, London on managing meningococcal disease.1-1 It detailed the authors' personal practice, a type of paper going out of fashion in these days of systematic reviews and meta-analyses. Our unfashionable behaviour was provoked by requests from paediatricians to help them cope with this dangerous condition. This month we report on whether the ends have justified the means. The St. Mary's group present an outcome audit comparing case fatality in 1997 with that of 1992 (page 386). Their paper follows a similar evaluation, from the Royal Liverpool Children's Hospital covering the period 1995–98 (page 382).

Both groups have used the paediatric risk of mortality score (PRISM) as a benchmark. Their results are encouraging. In these days of media inspired doctor bashing (surely not confined to the UK?) their results should be trumpeted abroad. The case fatality rate at St. Mary's fell from 29% to 2% over the five years of their audit, …