Acute bacterial meningitis: where do children die?

The case-fatality rate for acute bacterial meningitis in childhood is still disappointingly high. A review of 687 cases of acute bacterial meningitis including 72 deaths, identified in a defined population of children under ten years of age, was done to determine where patients were treated and where they died. Ten per cent of all hospital admissions were to infectious-disease hospitals, 16 per cent to teaching hospitals, and 74 per cent to general, non-teaching ("regional-board") hospitals. The case-fatality rates associated with these hospitals were three per cent, three per cent and 11 per cent respectively. The difference between regional-board and other hospitals was smaller, although still present, when children who died within a few hours of hospital admission were excluded from the analysis. Twenty-two per cent of all deaths (10 children who died outside hospital and six who were certified dead on admission) occurred before specialist care was reached. It may be possible to reduce the mortality from this disease by improving facilities for treatment in some hospitals. There is, however, an important residue of deaths--those which occur before hospital care is reached and, no doubt, some of those which occur soon after hospital admission--which would be unaffected by such improvements.