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The role of healthcare delivery in the outcome of meningococcal disease in children: Case-control study of fatal and non-fatal cases

Ninis, Nelly; Phillips, Claire; Bailey, Linda; Pollock, Jon I.; Nadel, Simon; Britto, Joseph; Maconochie, Ian; Winrow, Andrew; Coen, Pietro G.; Booy, Robert; Levin, Michael


Nelly Ninis

Claire Phillips

Linda Bailey

Jon Pollock
Associate Professor in Epidemiology

Simon Nadel

Joseph Britto

Ian Maconochie

Andrew Winrow

Pietro G. Coen

Robert Booy

Michael Levin


Objective: To determine whether suboptimal management in hospital could contribute to poor outcome in children admitted with meningococcal disease. Design: Case-control study of childhood deaths from meningococcal disease, comparing hospital care in fatal and non-fatal cases. Setting: National 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 measures: Predefined 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. Results: We 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. Conclusions: Suboptimal health care 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.


Ninis, N., Phillips, C., Bailey, L., Pollock, J. I., Nadel, S., Britto, J., …Levin, M. (2005). The role of healthcare delivery in the outcome of meningococcal disease in children: Case-control study of fatal and non-fatal cases. BMJ, 330(7506), 1475-1478.

Journal Article Type Article
Publication Date Jun 25, 2005
Deposit Date Jan 22, 2010
Journal British Medical Journal
Print ISSN 0959-8138
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 330
Issue 7506
Pages 1475-1478
Keywords healthcare delivery, meningococcal disease, children
Public URL
Publisher URL
Additional Information Additional Information : This study confirms the paramount importance of rapid assessment and intensive treatment in suspected cases of meningococcal disease in children with reviews by specialist centres where possible. Funded by the Meningitis Research Foundation.