The quality of evidence is downgraded by study limitations (lack of blinding), by indirectness (differences between the population of interest and those studied), and by imprecise results (few patients and outcome events).
A Cochrane review [Abstract] 1 evaluating differing volumes of fluid given in the initial management of bacterial meningitis included three studies with a total of 420 subjects. The studies included children between one month and sixteen years of age.
The largest of the three trials was conducted in settings with high mortality rates. The long delays before presentation and a high rate of malnutrition in the children in this study may have been associated with a high rate of dehydration at presentation. The meta-analysis found no significant difference between the maintenance-fluid and restricted-fluid groups in number of deaths (RR 0.82, 95% CI 0.53 to 1.27; 2 studies, n=407); acute severe neurological sequelae (RR 0.67, 95% CI 0.41 to 1.08; 2 studies, n=407); or in mild to moderate sequelae (RR 1.24, 95% CI 0.58 to 2.65; 1 study, n=357). However, when neurological sequelae were defined further, there was a statistically significant difference in favour of the maintenance-fluid group in regard to spasticity (RR 0.50, 95% CI 0.27 to 0.93; 1 study, n=357), seizures at both 72 hours (RR 0.59, 95% CI 0.42 to 0.83; 1 study, n=357) and 14 days (RR 0.19, 95% CI 0.04 to 0.88; 1 study, n=357), and chronic severe neurological sequelae at three-months follow up (RR 0.42, 95% CI 0.20 to 0.89; 1 study, n=351).
Primary/Secondary Keywords