Context In adults, adjuvant corticosteroids significantly reduce mortality associated with bacterial meningitis; however, in children, studies reveal conflicting results.Objective To determine the association between adjuvant corticosteroids and clinical outcomes in children with bacterial meningitis. Design, Setting, and PatientsA retrospective cohort study conducted between January 1, 2001, and December 31, 2006, of 2780 children discharged with bacterial meningitis as their primary diagnosis from 27 tertiary care children's hospitals located in 18 US states and the District of Columbia that provide data to the Pediatric Health Information System's administrative database.Main Outcome Measures Propensity scores, constructed using patient demographics and markers of illness severity at presentation, were used to determine each child's likelihood of receiving adjuvant corticosteroids. Primary outcomes of interest, time to death and time to hospital discharge, were analyzed by using propensity-adjusted Cox proportional hazards regression models stratified by age categories. ResultsThe median age was 9 months (interquartile range, 0-6 years); 57% of the patients were males. Streptococcus pneumoniae was the most commonly identified cause of meningitis. Adjuvant corticosteroids were administered to 248 children (8.9%). The overall mortality rate was 4.2% (95% confidence interval [CI], 3.5%-5.0%), and cumulative incidences were 2.2% and 3.1% at 7 days and 28 days, respectively, after admission. Adjuvant corticosteroids did not reduce mortality, regardless of age (children Ͻ1 year: hazard ratio [HR], 1.09; 95% CI, 0.53-2.24; 1-5 years: HR, 1.28; 95% CI, 0.59-2.78; and Ͼ5 years: HR, 0.92; 95% CI, 0.38-2.25). Adjuvant corticosteroids were also not associated with time to hospital discharge. In subgroup analyses, the results did not change in either children identified with pneumococcal or meningococcal meningitis or children with a cerebrospinal fluid culture performed at the admitting hospital.Conclusion In this multicenter observational study of children with bacterial meningitis, adjuvant corticosteroid therapy was not associated with time to death or time to hospital discharge.

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IntroductionCompetency-based medical education (CBME) presents a paradigm shift in medical training. This outcome-based education movement has triggered substantive changes across the globe. Since this transition is only beginning, many faculty members may not have experience with CBME nor a solid foundation in the grounding literature. We identify and summarize key papers to help faculty members learn more about CBME.MethodsBased on the online discussions of the 2016–2017 ALiEM Faculty Incubator program, a series of papers on the topic of CBME was developed. Augmenting this list with suggestions by a guest expert and by an open call on Twitter for other important papers, we were able to generate a list of 21 papers in total. Subsequently, we used a modified Delphi study methodology to narrow the list to key papers that describe the importance and significance for educators interested in learning about CBME. To determine the most impactful papers, the mixed junior and senior faculty authorship group used three-round voting methodology based upon the Delphi method.ResultsSummaries of the five most highly rated papers on the topic of CBME, as determined by this modified Delphi approach, are presented in this paper. Major themes include a definition of core CBME themes, CBME principles to consider in the design of curricula, a history of the development of the CBME movement, and a rationale for changes to accreditation with CBME. The application of the study findings to junior faculty and faculty developers is discussed.ConclusionWe present five key papers on CBME that junior faculty members and faculty experts identified as essential to faculty development. These papers are a mix of foundational and explanatory papers that may provide a basis from which junior faculty members may build upon as they help to implement CBME programs.

Children with bacterial meningitis often have additional morbidity due to systemic complications or associated focal infections indicated by increase use of acute in-hospital resource utilization. The apparent increase in in-hospital morbidity related to these conditions should be considered in future evaluations of vaccine efficacy, novel therapeutics, and hospital resource allocation.

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