Melley et al developed 2 models for predicting adverse outcomes in pediatric patients with invasive meningococcal infections. These can help identify patients who may benefit from more aggressive management or novel therapies. The authors are from Boston Children's Hospital, Harvard Medical School and the University of California at Davis.
Patient selection: Neisseria meningitidis bacteremia or meningitis with age < 20 years of age
Adverse outcomes:
(1) death
(2) amputation of a limb
(3) amputation of all 5 digits on an extremity
Parameters for model 1:
(1) absolute neutrophil count
(2) perfusion
(3) platelet count
Parameters for model 2:
(1) absolute neutrophil count
(2) fibrinogen concentration
|
Parameter |
Finding |
Points |
|
absolute neutrophil count |
>= 3,000 per µL |
0 |
|
|
< 3,000 per µL |
1 |
|
perfusion |
good to fair |
0 |
|
|
poor |
1 |
|
platelet count |
>= 150,000 per µL |
0 |
|
|
< 150,000 per µL |
1 |
|
fibrinogen concentration |
>= 250 mg/dL |
0 |
|
|
< 250 mg/dL |
1 |
where:
• Poor perfusion consists of (a) cool extremities, mottled skin or delayed capillary refill time (> 2 seconds) AND (b) low systolic blood pressure.
• Low systolic blood pressure was < 70 mm Hg if less than 1 month of age; < 80 mm Hg if 1 month to 4.99 years of age; < 90 mm Hg 5 years of age or older
total score for model 1 =
= (points for absolute neutrophil count) + (points for perfusion) + (points for platelet count)
total score for model 2 =
= (points for absolute neutrophil count) + (points for fibrinogen)
Interpretation:
• minimum score for both models: 0
• maximum score for model 1: 3
• maximum score for model 2: 2
• The higher the score the greater the risk of an adverse outcome.
|
Score for Model 1 |
Risk of Adverse Outcome |
Percent Affected |
|
0 |
low |
1% |
|
1 |
low to moderate |
7-12% |
|
2 |
high |
60-73% |
|
3 |
very high |
100% |
|
Score for Model 2 |
Risk of Adverse Outcome |
Percent Affected |
|
0 |
very low |
0% |
|
1 |
moderate |
17-25% |
|
2 |
high |
85-89% |
Specialty: Infectious Diseases, Pulmonology, Neurology
ICD-10: ,
