Ajayi-Obe et al described a prognostic score for evaluating patients during meningococcal epidemics in Africa. This is suited for low-resource settings. The authors are associated with the Federal Ministry of Health in Nigeria.
Patient selection: epidemic meningococcal disease (sepsis, meningitis, both), children and adults
Outcome: death
Parameter:
(1) systolic blood pressure in mm Hg and age in years
(2) heart rate in beats per minute
(3) respiratory rate in breaths per minute
(4) capillary refill time (CRT) in seconds
(5) paediatric coma scale (Simpson and Reilley; Children's Coma Scale; Adelaide's Coma Scale) from 3 to 15
(6) neck stiffness
(7) petechiae and/or purpura
|
Parameter
|
Finding
|
Points
|
|
systolic blood pressure and age
|
SBP > 75 and age < 4 years
|
0
|
|
|
SBP <= 75 mm Hg and age < 4 years
|
3
|
|
|
SBP > 85 mm Hg and age >= 4 years
|
0
|
|
|
SBP <= 85 mm Hg and age >= 4 years
|
3
|
|
heart rate
|
>= 140 beats per minute or feeble
|
1
|
|
|
< 140 beats per minute
|
0
|
|
respiratory rate
|
>= 50 breaths per minute and/or irregular
|
1
|
|
|
< 50 breaths per minute
|
0
|
|
capillary refill time
|
<= 3 seconds
|
0
|
|
|
> 3 seconds
|
1
|
|
paediatric coma scale
|
>= 8
|
0
|
|
|
<= 7
|
1
|
|
neck stiffness
|
yes
|
0
|
|
|
no
|
2
|
|
petechiae and/or purpura
|
yes
|
1
|
|
|
no
|
0
|
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• A score >= 9 was associated with mortality.
• A modified score without the systolic blood pressure and age was also described.
Performance:
• The sensitivity was 80% and specificity 94%.
