Sir.—We agree with Tesoro and Selbst1 that prognostic factors developed 30 years ago by Stiehm and Damrosch2 are no longer helpful in treating meningococcal infections. Like Tesoro and Selbst, we observed3 that, of 27 children with severe purpura, 17 (63%) had Stiehm-Damrosch scores of 3 or greater (sedimentation rate was not analyzed), and seven (41%) of these 17 survived. (Five [55%] of nine patients who had Stiehm-Damrosch scores of 3 or greater in the study by Tesoro
and Selbst survived.) The main problem with most scores proposed in the literature is that they were defined in patients of different ages (adults and children) and with different diseases (septicemia, with or without shock; purpura with meningitis; and meningitis without septicemia).4 Scores for all forms of meningococcal infections are helpful, especially in the emergency department, for indicating early transfer in an intensive care unit. However, for all physicians, shock is
LECLERC F, HUE V, MARTINOT A, DELEPOULLE F. Scoring Systems for Accurate Prognosis of Patients With Meningococcal Infections. Am J Dis Child. 1991;145(10):1090–1091. doi:10.1001/archpedi.1991.02160100022013
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