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Scoring System to Predict Morbidity in Hemophilus influenzae Meningitis

Purpose: To identify patients at risk for serious sequelae associated with Hemophilus influenzae meningitis using the score of Herson and Todd.

Description

Meningitis caused by Hemophilus influenzae can have a devastating effects, especially in young children. Herson and Todd developed a clinical score to identify patients at risk for severe morbidity or mortality associated with H. influenzae meningitis.


Major sequelae associated with H. influenzae meningitis include:

(1) blindness

(2) hydrocephalus

(3) institutionalization

(4) microcephaly

(5) quadriplegia

(6) severe mental retardation

(7) uncontrolled seizures

 

Minor sequelae associated with H. influenzae meningitis include:

(1) ataxia

(2) hearing loss

(3) hemiparesis

(4) hyperactivity

(5) peripheral facial palsy

(6) subdural effusions

 

Parameters used for clinical score:

(1) age of the patient

(2) duration of symptoms

(3) body temperature

(4) systolic blood pressure

(5) coma

(6) seizures

(7) hemoglobin

(8) CSF WBC count

(9) CSF glucose

 

Parameter

Finding

Points

age of patient

>= 12 months

0

 

< 12 months

1

duration of symptoms prior to treatment

<= 3 days

0

 

> 3 days

0.5

body temperature

>= 36.6 °C

0

 

< 36.6 °C (hypothermia)

2

systolic blood pressure

>= 60 mm Hg

0

 

< 60 mm Hg (shock)

1

severe coma

absent

0

 

present

3

seizures

absent

0

 

present

2

hemoglobin

>= 11 g/dL

0

 

< 11 g/dL

1

CSF WBC count

>= 1,000 per µL

0

 

< 1,000 per µL

1

CSF glucose

>= 20 mg/dL

0

 

< 20 mg/dL

0.5

 

score =

= SUM(points for all 9 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 12

• A score <= 4 was associated with no or minor sequelae.

• A score >= 4.5 was associated with major sequelae or death in 80% (8 of 10).

 

Limitation:

• The score was developed over 20 years ago, with better treatment and management options available today. However, it can still serve to separate patients into low and high risk categories.


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Specialty

Objective

ICD-10