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Improved outcome in severe meningococcal disease
  1. K Thorburn,
  2. A Thomson,
  3. A Hart
  1. Royal Liverpool Children’s Hospital Alder Hey, UK

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We thank Tibby et al and Pearson for their interest in our paper.1 We agree with Pearson that evidence for a fall in overall mortality in meningococcal septic shock would require a geographical community based study. We described mortality in severe meningococcal disease in a paediatric intensive care unit (PICU).

In our multispeciality PICU in the north west, we have observed a continued decrease in both actual PICU mortality and mortality adjusted for disease severity since the original study period (table 1). Paediatric index of mortality (PIM) is a more contemporary scoring system than PRISM (paediatric risk of mortality score), and so has been calibrated to the more recent decline in PICU mortality rates.2 PIM gives a score at point of first PICU contact.

This general trend of improving meningococcal outcome is also reflected in other PICUs. As shown by the results from St Mary’s PICU in London, where in a group with an overall actual mortality of 18.7% (PICU mortality for the study period being 10%, and an additional 8.7% mortality for the “unretrievables”), they encouragingly had managed to reduce the meningococcal PICU mortality in their “specialist PICU” from 23% to 2% (1992–97).3 Tibby et al, from Guy’s Hospital PICU in London (1998–2001), in their letter report a similar very low mortality rate.

There has been continued improvement in outcome from severe meningococcal disease throughout the UK. Early recognition and early institution of treatment are of paramount importance. No single centre holds the monopoly on the improved outcome in meningococcal disease. Although improved intensive care has undoubtedly contributed to this fall in mortality, there should be more recognition of the role of those in the community, parents and carers, general practitioners, and district general hospitals who have significantly contributed (and continue to contribute) to the survival of these critically ill children.

Table 1

Actual mortality, number of patients, mortality per year, and standardised mortality ratio (SMR) in patients admitted to the paediatric intensive care unit (PICU) at the Royal Liverpool Children’s Hospital with meningococcal disease