Predictive scores failing at identifying psychiatric disabilities following childhood bacterial meningitis calls for revision of current follow-up guidelines

IF 4 4区 医学 Q1 INFECTIOUS DISEASES
Urban Johansson Kostenniemi, S. Silfverdal
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引用次数: 0

Abstract

Abstract Backgrounds Psychiatric disabilities affect one in three survivors of bacterial meningitis. Since current guidelines do not recommend psychiatric follow-up in all children, disabilities are often detected late. Identifying children with elevated risk of psychiatric disabilities using predictive scores could be one strategy for detecting psychiatric disabilities without having to conduct psychiatric evaluations in all children. Therefore, we searched for existing predictive scores and later tested five predictive scores’ ability to predict psychiatric disabilities following childhood bacterial meningitis. Methods From an existing dataset, we selected 73 children with bacterial meningitis of whom 22 later developed psychiatric disease and 15 experienced concentration or learning difficulties. Using these, we tested each predictive score’s sensitivity at their cut-off level for predicting psychiatric disease and concentration or learning difficulties using a chi-square test. Furthermore, we performed a receiver operating characteristic curve (ROC) analysis to assert the area under the curve (AUC) as a measure of overall predictive performance. Results The sensitivity of each predictive score’ ranged from 6 to 38% for psychiatric disease and from 8 to 57% for concentration or learning difficulties. In the ROC-analysis, the AUC was 0.59–0.73 and 0.53–0.72, respectively. Conclusions All predictive score failed at identifying children later developing psychiatric disabilities, excluding this as a feasible strategy for detecting psychiatric disabilities. Hence, current guidelines for bacterial meningitis need to be revised to recommend psychiatric evaluations in all children. KEY NOTES Current guidelines not recommending psychiatric evaluations in all children following bacterial meningitis may result in late detection of psychiatric disabilities. We tested predictive scores’ ability to identify children later developing psychiatric disabilities following bacterial meningitis. All predictive score failed at identifying children later developing psychiatric disabilities, excluding this as a feasible strategy. Hence, current guidelines for bacterial meningitis need to be revised to recommend psychiatric evaluations in all children.
预测评分不能识别儿童细菌性脑膜炎后的精神残疾,这要求修订现行的随访指南
背景:三分之一的细菌性脑膜炎幸存者患有精神障碍。由于目前的指导方针不建议对所有儿童进行精神病学随访,因此残疾往往很晚才被发现。使用预测分数来识别精神残疾风险较高的儿童可能是一种检测精神残疾的策略,而不必对所有儿童进行精神评估。因此,我们搜索了现有的预测分数,并随后测试了五种预测分数预测儿童细菌性脑膜炎后精神残疾的能力。方法从现有数据集中,我们选择了73名患有细菌性脑膜炎的儿童,其中22名后来发展为精神疾病,15名出现注意力集中或学习困难。使用这些方法,我们使用卡方检验在预测精神疾病、注意力集中或学习困难的截止水平上测试每个预测分数的敏感性。此外,我们进行了受试者工作特征曲线(ROC)分析,以确定曲线下面积(AUC)作为总体预测性能的衡量标准。结果各预测评分对精神疾病的敏感性为6% ~ 38%,对注意力集中或学习困难的敏感性为8% ~ 57%。roc分析的AUC分别为0.59 ~ 0.73和0.53 ~ 0.72。结论:所有预测评分都不能识别儿童后来发展为精神障碍,排除了这作为检测精神障碍的可行策略。因此,目前的细菌性脑膜炎指南需要修订,以推荐对所有儿童进行精神病学评估。目前的指南不建议对所有细菌性脑膜炎患儿进行精神病学评估,这可能导致精神障碍的晚期发现。我们测试了预测分数识别儿童在细菌性脑膜炎后发展为精神残疾的能力。所有的预测评分都无法识别儿童后来发展为精神障碍,排除了这一可行策略。因此,目前的细菌性脑膜炎指南需要修订,以推荐对所有儿童进行精神病学评估。
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来源期刊
Infectious Diseases
Infectious Diseases INFECTIOUS DISEASES-
CiteScore
8.20
自引率
1.70%
发文量
92
审稿时长
8 weeks
期刊介绍: Infectious Diseases (formerly Scandinavian Journal of Infectious Diseases) is a peer-reviewed journal publishing articles on all aspects of human infection, including pathogenesis, diagnosis, and treatment of infectious diseases, and also on medical microbiology and epidemiology
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