ArticleBMJ (Clinical research ed.)2005
The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases.
Article in BMJ (Clinical research ed.), 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 44 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
44 citing papers in PubMed, 3 syntheses or guidelines pooled it, 182 citations in OpenAlex.
- Pooled it
- Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012.Intensive care medicine · 2013Guideline
- Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine.Critical care medicine · 2009Guideline
- ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation.Intensive care medicine · 2008Trial
- Derivation and Validation of Predictive Models for Early Pediatric Sepsis.JAMA pediatrics · 2025Article
- Relationship between molecular pathogen detection and clinical disease in febrile children across Europe: a multicentre, prospective observational study.The Lancet regional health. Europe · 2023Article
- Article
- Prevalence, Characteristics, and Determinants of Suboptimal Care in the Initial Management of Community-Onset Severe Bacterial Infections in Children.JAMA network open · 2022Article
- Management of Children With Fever at Risk for Pediatric Sepsis: A Prospective Study in Pediatric Emergency Care.Frontiers in pediatrics · 2020Article
- Effects of saline or albumin fluid bolus in resuscitation: evidence from re-analysis of the FEAST trial.The Lancet. Respiratory medicine · 2019Article
- Epidemiology of Pediatric Septic Shock.Journal of pediatric intensive care · 2019Review
- Continuum of care in pediatric sepsis: a prototypical acute care delivery model.Translational pediatrics · 2018Review
- Sepsis in the burn patient: a different problem than sepsis in the general population.Burns & trauma · 2017Review
- Short-term changes in the health state of children with group B meningococcal disease: A prospective, national cohort study.PloS one · 2017Article
- Goal directed therapy for suspected acute bacterial meningitis in adults and adolescents in sub-Saharan Africa.PloS one · 2017Article
- 2016 Update for the Rogers' Textbook of Pediatric Intensive Care: Recognition and Initial Management of Shock.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2016Review
- Identifying improvements to complex pathways: evidence synthesis and stakeholder engagement in infant congenital heart disease.BMJ open · 2016Article
- Article
- Why do young children die in the UK? A comparison with Sweden.Archives of disease in childhood · 2015Article
- Goal-Directed Resuscitative Interventions During Pediatric Interfacility Transport.Critical care medicine · 2015Article
Corrections and comments
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- Erratum issued
Authors and funding
11 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine whether suboptimal management in hospital could contribute to poor outcome in children admitted with meningococcal disease.
designCase-control study of childhood deaths from meningococcal disease, comparing hospital care in fatal and non-fatal cases.
settingNational statistics and hospital records. SUBJECTS: All children under 17 years who died from meningococcal disease (cases) matched by age with three survivors (controls) from the same region of the country.
main outcome measuresPredefined criteria defined optimal management. A panel of paediatricians blinded to the outcome assessed case records using a standardised form and scored patients for suboptimal management.
resultsWe identified 143 cases and 355 controls. Departures from optimal (per protocol) management occurred more frequently in the fatal cases than in the survivors. Multivariate analysis identified three factors independently associated with an increased risk of death: failure to be looked after by a paediatrician, failure of sufficient supervision of junior staff, and failure of staff to administer adequate inotropes. Failure to recognise complications of the disease was a significant risk factor for death, although not independently of absence of paediatric care (P = 0.002). The odds ratio for death was 8.7 (95% confidence interval 2.3 to 33) with two failures, increasing with multiple failures.
conclusionsSuboptimal healthcare delivery significantly reduces the likelihood of survival in children with meningococcal disease. 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.