Factors affecting outcome in meningococcal infections

Article Abstract:

To learn more concerning the prognosis of children with infections caused by meningococcal bacterial strains (of which there are at least 13), the medical records of 73 children (aged 1 month to 15 years) with that diagnosis were reviewed. Meningococcal infections are associated with bacteremia (bacteria in the blood), systemic infection, rash, and, in severe cases, meningitis (inflammation of the membranes that surround the brain and spinal cord). Five factors have been considered predictive of a poor outcome for meningococcal disease: onset of tiny skin hemorrhages (petechiae) within the 12 hours before a physician is called; presence of shock (a systemic reaction to infection); normal or low white blood cell count; normal or low sedimentation rate (the rate at which red blood cells settle in a test tube, a measure of disease); and the absence of meningitis. In the current study, seven deaths occurred (mortality of 10 percent). Absence of meningitis was not associated with poorer survival, and it appeared to be the presence of petechia, rather than the time course of their appearance, that predicted death. Thus, 7 of 37 children with petechiae when they were examined died, while all the 36 children without petechiae survived. Mortality was, indeed, higher for lower white blood counts; sedimentation rates were not recorded. Six of 19 patients in shock died, but only 1 of 53 patients who did not develop shock died. Another factor associated with death from meningococcal infection was visiting another hospital before transfer to the facility where the study was carried out. Finally, 7 of the 17 patients whose consciousness was dulled, or who were comatose, died; none of the remaining 56 patients died. A changed mental status was a strong predictor of a poor outcome, but the absence of meningitis was not an important predictor. The traditional criteria are better at predicting good outcomes than poor ones. This may be the result of improved treatment since the criteria were developed in 1966. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression, Meningococcal infections

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Cardiopulmonary resuscitation policies and practices: a statewide nursing home study

Article Abstract:

Cardiopulmonary resuscitation (CPR) is a commonly practiced method of emergency lifesaving. Decisions regarding the application of CPR are made by competent patients or family members of incompetent patients. CPR policies in nursing homes can be used to assess whether the personal wishes of their residents are being respected. In a survey of 209 long-term nursing homes in North Carolina regarding CPR policies, 83 percent reported having a written policy on CPR. CPR was performed in nine out of 10 nursing homes. CPR could be restricted by physician's orders in 92 percent of the homes. Ten ethical, legal and procedural principles stated in the model policy were used for comparison. Ethical and legal principles of policies included the patients right to decide, informed consent (communication of 'do not resuscitate', or DNR, orders), patient competency, dignity and quality of care and the notification of treatment alternatives. Procedural provisions included authorization, documentation, patient identification, evaluation of DNR and review of patient's condition to see if DNR orders are applicable. The policies of long-term nursing homes varied widely. Procedural provisions were followed in more than half of the nursing homes. Fewer than half had criteria regarding patient's autonomy, treatment alternatives, dignity and quality of care and patient identification. To improve the decision-making of nursing home residents, all 10 CPR policy criteria should be included. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Surveys, Nursing homes, Medical policy, Health policy, CPR (First aid), Cardiopulmonary resuscitation

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Prediction of in-hospital cardiopulmonary arrest outcome

Article Abstract:

Characteristics of 122 patients who received cardiopulmonary resuscitation (CPR) are reviewed in order to develop a model for predicting the immediate success of resuscitation, which involves the restoration of pulse and blood pressure. Factors which were available before resuscitation was performed are considered. These include: age, diagnosis, measurement of the severity of illness, laboratory data and progress of the patient's illness. Four factors are identified as having predictive value: age between 40 and 70 years, scheduling for surgery (not emergency), location of cardiac arrest in an intensive care unit and blood oxygen level (PO2) greater than 8mm of mercury. This model predicts the success of resuscitation in 69 percent of cases.

Methods, Case studies, Evaluation, Hospitalization, Cardiac arrest, Hospital care, Cardiac resuscitation

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