Meningococcal disease remains the most common infectious cause of death in children in many developed countries. Most patients present to their nearest emergency department but, because the disease can progress very rapidly, many die before they can be transferred to specialist units.
Researchers identified all deaths from meningococcal disease in UK children aged 0-16 years between December 1997 and February 1999. For each death (case) they identified three survivors (controls) matched by age from the same region of the country.
A panel of paediatricians reviewed each case to assess the promptness and quality of emergency medical care provided in the first 24 hours after admission, according to published protocols.
A total of 143 cases and 355 controls were included in the study. Failures in management were significantly more common in children who died than in survivors.
Independent risk factors for death included failure to be looked after by a paediatrician, insufficient supervision of junior staff, and failure to administer adequate drugs to treat shock and organ damage. Failure to recognise complications of meningococcal disease was also a risk factor, although this was linked with absence of paediatric care.
Suboptimal healthcare delivery significantly reduces the likelihood of survival in children with meningococcal disease, say the authors. Improved training of medical and nursing staff, adherence to published protocols, and increased supervision by consultants may improve the outcome for these children and also those with other life threatening illnesses, they conclude.