Prediction of academic and behavioural limitations in school-age survivors of bacterial meningitis.

Koomen I, Grobbee DE, Roord JJ, Jennekens-Schinkel A, van der Lei HDW, Kraak MAC, vanFurth AM. Prediction of academic and behavioural limitations in school-age survivors of bacterialmeningitis. Acta Paediatr 2004; 93: 1378–1385. Stockholm. ISSN 0803-5253Aim: To develop a prediction rule to identify postmeningitic children at high risk of academic andbehavioural limitations. Methods: 182 children (mean age 10 y; range 5–14) were selected from acohort of 674 school-age survivors of bacterial meningitis. These children had neither meningitiswith “complex onset”, nor prior cognitive or behavioural problems, nor severe disease sequelae.On average, 7 y after the meningitis, they were evaluated using an “Academic Achievement Test”,and their parents filled in the “Child Behaviour Checklist”. By reviewing the medical records,potential risk factors for academic and/or behavioural limitations were collected. Independentpredictors were identified using multivariate logistic regression analysis, leading to the formulationof a prediction rule. Results: The cumulative incidence of academic and/or behavioural limitationsamong children who survived bacterial meningitis without severe disease sequelae was 32%. Theprediction rule was based on nine independent risk factors: gender, birthweight, educational levelof the father, S. pneumoniae, cerebrospinal fluid leukocyte count, delay between admission andstart of antibiotics, dexamethasone use, seizures treated with anticonvulsive therapy, and prolongedfever. When 10 was taken as a cut-off point for the risk score computed using this rule, 76% ofthe children with limitations could be identified, while 38% of the children in the cohort wereselected as at risk for these limitations.Conclusion: With a prediction rule based on nine risk factors, postmeningitic children at highrisk of developing academic and/or behavioural limitations could be identified. Additionalresearch is required to further validate this prediction rule. In the future, a careful follow-up ofhigh risk children may enhance early detection and treatment of these limitations.Key words: Bacterial meningitis, cohort study, nested case-control study, prediction, sequelaeMarceline van Furth, VU Medical Centre, Department of Paediatrics, PO Box 7057, 1007 MBAmsterdam, The Netherlands (Tel. 31 204442419, fax. 31 204442422, e-mail. am.vfurth@vumc.nl)