Biomedical subjects

A P Thomson

Publications and source records attributed to A P Thomson.

10 recordsLinked to original sources

PubMed1991

Validation of the Glasgow Meningococcal Septicemia Prognostic Score: a 10-year retrospective survey.

OBJECTIVE: To derive performance characteristics for the Glasgow Meningococcal Septicemia Prognostic Score (GMSPS). DESIGN: Retrospective case-note study. SETTING: Two children's hospitals with Regional Intensive Care Unit. PATIENTS: One hundred twenty-three children with proven meningococcal septicemia (some with concurrent meningitis) from January 1, 1977 to December 31, 1986. MEASUREMENTS AND MAIN RESULTS: All 14 children who died after arrival scored greater than or equal to 8 either on admission (n = 8) or afterward (n = 6). Of 109 survivors, five scored greater than or equal to 8 (two were postictal at the time of scoring). A GMSPS of greater than or equal to 10 at or after admission predicted death with sensitivity 100%, specificity 98%, and positive predictive value of 88%; for GMSPS of both greater than or equal to 8 or 9, the values were 100%, 95%, and 74%, respectively. CONCLUSIONS: The GMSPS is a rapid clinical score that performs well in identifying children with poor prognosis who might benefit from early intensive care. It should be studied prospectively and compared with other scoring systems.

Child↗

PubMed1991

Features and outcome in meningococcal disease presenting with maculopapular rash.

Sixty nine patients with meningococcal disease some of whom presented with a maculopapular rash were entered in a prospective multicentre study. The clinical and laboratory features of children presenting with maculopapular rashes were compared with those of children presenting with typical haemorrhagic rashes. Of the 69 children 26 (38%) developed maculopapular rashes; nine (13%) had a maculopapular rash only, and the remaining 17 had a mixed maculopapular-purpuric rash. Twelve of the 17 (7%) had less than 12 petechiae. Children with maculopapular rashes had significantly higher platelet counts (median 294 compared with 243 x 10(9)/l), and plasma total haemolytic complement activity (80.5 compared with 65.0 U/ml) and significantly lower Glasgow meningococcal septicaemia prognostic scores (2.5 compared with 5.5) than those with purpuric rashes on admission. There were no significant differences between the groups in mortality, white cell count or absolute neutrophil count on admission, or C reactive protein concentration. Meningococcal disease can present with a maculopapular rash alone but this does not necessarily mean that the disease is less severe.

Complement Hemolytic Activity Assay↗

PubMed1988

Endotoxinaemia in sickle cell disease.

Fifty-nine children with sickle cell anaemia (HbSS) or associated haemoglobinopathies were studied prospectively using a chromogenic Limulus amoebocyte lysate assay to detect circulating endotoxin. The 41 children with HbSS (mean age 8 years 9 months) had more serious disease than the 18 with HbSC disease (n = 14) or HbS-beta-thalassaemia (n = 4) (mean age 7 years 2 months), with a greater degree of splenomegaly, lower haemoglobin, and higher white cell counts, platelet counts and bilirubin values (P less than 0.05 for all). Twenty-nine children with HbSS had evidence of poor reticuloendothelial function, with red cell pitting of greater than or equal to 2%. Three of these 29 had low levels of endotoxin in plasma (0.12-0.24 endotoxin units (EU)/ml); two were clinically well, one had a painful crisis. Eight of 18 children with other sickle haemoglobinopathies had greater than or equal to 2% pitted red cells; none was endotoxinaemic. Therefore, in 37 patients with reticuloendothelial dysfunction, three were endotoxinaemic; all had sickle cell anaemia. Although not statistically significant, this suggests that endotoxinaemia may occur predominantly in patients with reticuloendothelial dysfunction, and is compatible with the hypothesis that systemic endotoxinaemia can derive from the intestine especially when reticuloendothelial function is depressed.

Adolescent↗

PubMed1988

Diagnosis of functional illness presenting with gait disorder.

Nine children presented with disturbances of gait that were not caused by organic disease. They all fulfilled at least four out of eight diagnostic criteria. Diagnosis in all had been delayed while organic causes were excluded. Unnecessary and sometimes potentially harmful procedures were performed or proposed for each child. Identification of such children earlier may avoid morbidity and facilitate management.

Adolescent↗

PubMed1988

Cerebral palsy: a 1987 perspective.

Changing views on reaching a diagnosis, methods of assessment, and management are apparent for neurological disorders in general, and cerebral palsy in particular. A personal approach to the problems associated with the evaluation and care of children and young people with cerebral palsy is outlined, with particular emphasis on the contributions form, and optimal use of, the multidisciplinary assessment team.

Adolescent↗

PubMed1988