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Published on: June 21, 2018
Management of suspected paediatric meningitis: a multicentre prospective cohort study
Roshan Ramasamy1, Louise Willis2, Seilesh Kadambari3
1Department of Emergency Medicine, Northwick Park Hospital, London, UK.
Insights
Delays in pediatric meningitis care are common, with most children receiving antibiotics before lumbar puncture (LP). This practice reduces diagnostic accuracy and prolongs hospital stays, highlighting critical areas for management improvement.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Management of Meningitis
- Diagnostic Delays in Healthcare
Background:
- Meningitis is a serious infection requiring timely diagnosis and treatment.
- Current management protocols aim for rapid assessment and intervention.
- Understanding delays in care is crucial for improving patient outcomes.
Purpose of the Study:
- To quantify delays in the management of pediatric meningitis.
- To identify specific points of delay in prehospital and in-hospital care.
- To assess the impact of these delays on diagnostic yield and treatment effectiveness.
Main Methods:
- A multicenter prospective cohort study involving 388 children under 16 with suspected meningitis.
- Data collection included prehospital and in-hospital assessment times, lumbar puncture (LP) timing, antibiotic administration, and discharge.
- Cerebrospinal fluid (CSF) microbiological results, including PCR, were analyzed.
Main Results:
- 57% of children received medical assessment prehospitalization.
- Median time from hospital assessment to LP was 4.8 hours; to antibiotics was 3.1 hours.
- 62% of children underwent LP after antibiotic administration, with underuse of PCR testing for common pathogens.
Conclusions:
- Most pediatric meningitis cases experience delays, particularly with LP after antibiotic initiation.
- Delayed LP and underutilization of PCR reduce diagnostic accuracy for bacterial meningitis.
- These deficiencies contribute to prolonged hospital stays and unnecessary antibiotic use.
Objective:
To quantify delays during management of children with suspected meningitis.
Design:
Multicentre prospective cohort study.
Setting:
Three UK tertiary paediatric centres; June 2011-June 2012 PATIENTS: 388 children aged <16 years hospitalised with suspected meningitis or undergoing lumbar puncture (LP) during sepsis evaluation.
Main Outcome Measures:
Time of prehospital and in-hospital assessments, LP, antibiotic treatment and discharge; types of prehospital medical assessment and microbiological results. Data collected from hospital records and parental interview.
Results:
220/388 (57%) children were seen by a medical professional prehospitalisation (143 by a general practitioner). Median times from initial hospital assessment to LP and antibiotic administration were 4.8 hours and 3.1 hours, respectively; 62% of children had their LP after antibiotic treatment. Median time to LP was shorter for children aged <3 months (3.0 hours) than those aged 3-23 months (6.2 hours, P<0.001) or age ≥2 years (20.3 hours, P<0.001). In meningitis of unknown cause, cerebrospinal fluid (CSF) PCR was performed for meningococcus in 7%, pneumococcus in 10% and enterovirus in 76%. When no pathogen was identified, hospital stay was longer if LP was performed after antibiotics (median 12.5 days vs 5.0 days, P=0.037).
Conclusions:
Most children had LP after antibiotics were administered, reducing yield from CSF culture, and PCRs were underused despite national recommendations. These deficiencies reduce the ability to exclude bacterial meningitis, increasing unnecessary hospital stay and antibiotic treatment.
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