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

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.