MeningiSSS: A New Predictive Score to Support Decision on Invasive Procedures to Monitor or Manage the Intracerebral Pressure in Children with Bacterial Meningitis

Abstract

Background: Knowing the individual child's risk is highly useful when deciding on treatment strategies, especially when deciding on invasive procedures. In this study, we aimed to develop a new predictive score for children with bacterial meningitis and compare this with existing predictive scores and individual risk factors. Methods:We developed the Meningitis Swedish Survival Score (MeningiSSS) based on a previous systematic review of risk factors. From this, we selected risk factors identified in moderate-to-high-quality studies that could be assessed at admission to the hospital. Using data acquired from medical records of 101 children with bacterial meningitis, we tested the overall capabilities of the MeningiSSS compared with four existing predictive scores using a receiver operating characteristic curve (ROC) analysis to assert the area under the curve (AUC). Finally, we tested all predictive scores at their cut-off levels using a Chi-square test. As outcome, we used a small number of predefined outcomes; inhospital mortality, 30-day mortality, occurrence of neurological disabilities at discharge defined as Pediatric Cerebral Performance Category Scale category two to five, any type of complications occurring during the hospital stay, use of intensive care, and use of invasive procedures to monitor or manage the intracerebral pressure. Results:For identifying children later undergoing invasive procedures to monitor or manage the intracerebral pressure, the MeningiSSS excelled in the ROC-analysis (AUC = 0.90) and also was the only predictive score able to identify all cases at its cut-off level (25 vs 0%, p < 0.01). For intensive care, the MeningiSSS (AUC = 0.79) and the Simple Luanda Scale (AUC = 0.75) had the best results in the ROC-analysis, whereas others performed less well (AUC ≤ 0.65). Finally, while none of the scores' results were significantly associated with complications, an elevated score on the Mening-iSSS (AUC = 0.70), Niklasson Scale (AUC = 0.72), and the Herson-Todd Scale (AUC = 0.79) was all associated with death. Conclusions:The MeningiSSS outperformed existing predictive scores at identifying children later having to undergo invasive procedures to monitor or manage the intracerebral pressure in children with bacterial meningitis. Our results need further external validation before use in clinical practice. Thus, the MeningiSSS could potentially be helpful when making difficult decisions concerning intracerebral pressure management.

Global Case Fatality of Bacterial Meningitis During an 80-Year Period

“…The design was observational in 330 studies (94%) and interventional in 20 (6%) studies, with 12 to 22 831 (median [IQR], 115 [61-270]) episodes per study, and the inclusion period’s length varying from 3 months to 36 years (median [IQR], 5 [2-10] years). Studies included neonates (59 studies [16%]; 6549 episodes [4%]), children (101 studies [27%]; 21 511 episodes [14%]), adults (64 studies [17%]; 15 362 episodes [10%]), neonates and children (68 studies [18%]; 26 992 episodes [17%]),…”

Autoimmune and inflammatory neurological disorders in the intensive care unit

“…Limited data might also be extrapolated from the growing use of ICP monitors in infectious meningoencephalitis [35], especially amongst children [36]. There are no guidelines-based recommendations for ICP monitor placement outside of TBI but a recent scoring system was proposed for meningoencephalitis [37]. Brain tissue oxygenation monitoring and microdialysis catheters have been infrequently used in the management cerebral edema in meningoencephalitis and surgical decision making and warrant further investigation [38,39].…”

The brain in pediatric critical care: unique aspects of assessment, monitoring, investigations, and follow-up

“…[72] However, since such monitoring has limited links with outcome, invasive monitoring is used sparingly in these conditions In the example of bacterial meningitis in PICU, risk stratification tools have shown the potential to identify where invasive monitoring benefits outweigh the risks through personalised treatment pathways. [73] There is insufficient evidence to recommend the use of partial pressure of brain tissue oxygen (PbrO 2 ) monitoring. [67] Though, if such monitoring is used, a minimum value of 10mmHg is supported.…”