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I (of course) admit all patients with presumed bacterial meningitis to the =
hospital.  However, I think the issue being bantered about is what is the =
actual risk to the patient with bacterial meningitis who otherwise does =
not need to be admitted just to receive i.v. antibiotics.  One answer =
would be obtained from a literature search of complications not apparent =
in the ED for these patients and when they occur.  Baraff reviewed =
reported mortality and sequalae in 4920 children (abstract below) with =
bacterial meningitis.   It makes me wonder if we could prospectively =
identify patients with bacterial meningitis who might need only short term =
hospitalization or extended ED-based observation.
Tom Terndrup, MD
Syracuse
 
Authors Baraff LJ. Lee SI. Schriger DL. Institution UCLA Emergency =
Medicine Center 90024. Title Outcomes of bacterial meningitis in children: =
a meta-analysis.Source Pediatric Infectious Disease Journal. 12(5):389-94, =
1993 May.
Abstract We abstracted the results of all English language reports of the =
outcomes of bacterial meningitis published after 1955. We used hierarchical=
 Bayesian meta-analysis to determine the overall and organism-specific =
frequencies of death and persistent neurologic sequelae in children 2 =
months to 19 years of age. A total of 4920 children with acute bacterial =
meningitis were included in 45 reports that met the inclusion criteria. =
Children described in the 19 reports of prospectively enrolled cohorts =
from developed countries had lower mortality (4.8% vs. 8.1%) and were more =
likely to have no sequelae (82.5% vs. 73.9%). In these 19 studies 1602 =
children were evaluated for at least 1 sequela after hospital discharge. =
The mean probabilities of these sequelae were: deafness, 10.5%; bilateral =
severe or profound deafness, 5.1%; mental retardation, 4.2%; spasticity =
and/or paresis, 3.5%; seizure disorder, 4.2%; and no detectable sequelae, =
83.6%. Mean probabilities of outcomes varied significantly by etiologic =
bacteria, e.g. mortality: Haemophilus influenzae, 3.8%; Neisseria =
meningitis, 7.5%; Streptococcus pneumoniae, 15.3%.=20
 
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