• Alvaro Castellanos-Ortega, Miguel Delgado-Rodríguez, Javier Llorca, Pilar Sánchez Burón, Santiago Mencía Bartolomé, Antonio Soult Rubio, Guillermo Milano Manso, Pedro Domínguez Sampedro, Ramiro Blanco Montero, Antonio Rodríguez Núñez, Elisa Zambrano Pérez, Corsino Rey Galán, Nuria López Negueruela, and Roberto Reig Sáenz.
• Department of Intensive Care Medicine, Pediatric Intensive Care Unit, Residencia Cantabria, Hospital Universitario Marqués de Valdecilla, Avenida Cazoña s/n, 39011 Santander, Spain. uci-cantabria@humv.es
• Intensive Care Med. 2002 Mar 1; 28 (3): 341-51.

ObjectiveTo develop a quick and sensitive method for identification of children with presumed meningococcal septic shock at risk of death at admission to the pediatric intensive care unit (PICU) and to compare its performance with three other prognostic systems: Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS), Malley score and the Paediatric Index of Mortality (PIM).DesignMulticenter retrospective cohort study.SettingPICUs of 14 tertiary hospitals.PatientsThe developmental sample included 192 children consecutively admitted to the PICUs with presumed or confirmed meningococcal septic shock from 1983 to 1995. The validation sample included 158 children consecutively admitted from 1996 to 1998.InterventionsClinical and laboratory data gathered during the first 2 h after admission were used to develop the new score and to compute the other scoring systems. Logistic regression was applied to identify the independent predictors of death.Measurements And ResultsOverall mortality was 31.5%. The new score included seven variables: cyanosis (2 points), Glasgow coma scale less than 8 (2 points), refractory hypotension (2 points), oliguria (1 point), leukocytes less than 4000/mm(3) (1 point), partial thromboplastin time more than 150% of control value (1 point) and base deficit more than 10 mmol/l (1 point). The new score provided the best discriminative capability, as measured by the area under the ROC curve (SEM) in the validation sample =0.88 (0.03), PIM =0.82 (0.04), Malley I =0.80 (0.04), GMSPS =0.79 (0.04) and Malley II =0.76 (0.04).ConclusionsA new prognostic score is proposed for therapeutic stratification of children with presumed meningococcal septic shock.

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