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Báo cáo y học: "Outcome research in meningococcal septic shock"

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  1. Available online http://ccforum.com/content/12/1/402 Letter Outcome research in meningococcal septic shock Corinne Buysse1, Lindy Vermunt2, Elisabeth Utens2, Koen Joosten1 and Jan Hazelzet1 1Erasmus MC-Sophia Children’s Hospital, Department of Paediatrics, Division of Paediatric Intensive Care, Rotterdam, the Netherlands 2Erasmus MC-Sophia Children’s Hospital, Department of Child and Adolescent Psychiatry, Rotterdam, the Netherlands Corresponding author: Corinne Buysse, c.buysse@erasmusmc.nl Published: 17 January 2008 Critical Care 2008, 12:402 (doi:10.1186/cc6206) This article is online at http://ccforum.com/content/12/1/402 © 2008 BioMed Central Ltd See related commentary by Paize and Playfor, http://ccforum.com/content/11/5/172 and related research by Maat et al., http://ccforum.com/content/11/5/R112 We thank Dr Paize and Dr Playfor for their comments [1] The second part of our study concerned a cross-sectional regarding our earlier article in Critical Care [2]. long-term outcome study of all 179 survivors of septic shock and purpura requiring intensive care treatment between 1988 In their commentary Dr Paize and Dr Playfor stated that the and 2001, and their parents [3,5,6]. Regarding long-term reasons for a marked reduction in the mortality of children health-related quality of life, we found significantly lower with meningococcal disease in the paediatric intensive care scores in patients – mainly on physical domains (physical unit are multifactorial: increased centralization of the functioning, general health perception) – compared with paediatric intensive care unit, improvement in awareness, Dutch normative data [3]. Adolescents (aged 12–17 years) clinical guidelines for children with sepsis, and incorporation who survived meningococcal septic shock in childhood, of meningococcal serogroup C vaccine. especially those with skin scarring due to purpura, reported lower self-esteem compared with reference adolescents [5]. Dr Paize and Dr Playfor also regretted in their commentary Overall, we found favourable long-term behavioural, emotional that we did not examine morbidity in our large cohort [1]. We and post-traumatic stress outcomes in patients [6]. completely agree with Dr Paize and Dr Playfor that both short-term and long-term outcomes in survivors of meningo- Articles regarding skin scarring, orthopaedic and neurological coccal sepsis are clinically highly relevant. Only a few, sequelae, as well as psychosocial adjustment of parents, are unsystematic studies have been conducted in this field. under review. These studies used small, heterogeneous patient samples and unstandardized assessment procedures and were In conclusion, we would like to reassure Dr Paize and Dr focused mainly on short-term outcome. Our relatively large, Playfor that we did study short-term and long-term morbidity homogeneous cohort therefore offered the possibility to in survivors of septic shock and purpura. investigate this neglected area of outcome, both from a Competing interests medical and psychosocial point of view, with standardized procedures. Parts of our outcome study have been published The authors declare that they have no competing interests. already or are in press [3-6]. References 1. Paize F, Playfor SD: Improvements in the outcome of children In a prospective cohort study we performed a short-term with meningococcal disease [commentary]. Crit Care 2007, follow-up of all consecutive children with septic shock and 11:172. purpura requiring intensive care treatment between 2001 and 2. Maat M, Buysse CM, Emonts M, Spanjaard L, Joosten KF, Groot RD, Hazelzet JA: Improved survival of children with sepsis and 2005, and their parents [4]. Up to 2 years after paediatric purpura: effects of age, gender, and era. Crit Care 2007, 11: intensive care unit discharge, chronic complaints were R112. 3. Buysse CM, Raat H, Hazelzet JA, Vermunt LC, Utens EM, Hop reported in nearly one-half of the children. Significantly lower WC, Joosten KF: Long-term health-related quality of life in sur- scores were found on health-related quality-of-life scales vivors of meningococcal septic shock in childhood and their concerning mainly physical functioning and health perception parents. Qual Life Res 2007, 16:1567-1576. 4. Buysse CMP, Raat H, Hazelzet JA, Hop WCJ, Maliepaard M, in comparison with normative data. Quite a few mothers Joosten KFM: Surviving meningococcal septic shock: health suffered from anxiety or depression requiring professional consequences and quality of life in children and their parents up help. to 2 years after PICU discharge. Crit Care Med 2008, in press. Page 1 of 2 (page number not for citation purposes)
  2. Critical Care Vol 12 No 1 Buysse et al. 5. Vermunt LC, Buysse CMP, Joosten KFM, Oranje AP, Hazelzet JA, Verhulst FC, Utens EM: Self-esteem in children and adoles- cents after septic shock caused by Neisseria meningitidis: scars do matter. J Adolesc Health 2008, in press. 6. Vermunt LCAC, Buysse CMP, Joosten KFM, Hazelzet JA, Verhulst FC, Utens EM: Behavioral, emotional and post-traumatic stress problems in children and adolescents long-term after septic shock caused by Neisseria meningitidis. Br J Clin Psychology 2007, 24:[Epub ahead of print]. Page 2 of 2 (page number not for citation purposes)
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