Children admitted for observation for suspected meningitis. Problems in diagnosis in general practice

Infectious diseases in children are common in general practice. It is crucial not to overlook a case of purulent meningitis, and the aim of the present study was to evaluate and suggest ways of improving the diagnostic ability of the general practitioners in this respect. During a seven-year period 157 children under the age of 16 years, out of a population of 10,500 children, were referred from general practice to a district hospital for observation with symptoms and signs that suggested a possible diagnosis of meningitis. Seventy-eight underwent lumbar puncture, but only 14 of them received a final diagnosis of purulent meningitis. During the same period three other children proved to be cases of purulent meningitis, though they had been referred with other diagnosis. Twenty children had aseptic meningitis or encephalitis. The clinical findings in the groups of children with and without purulent meningitis were very similar, but an impaired level of consciousness and presence of petechiae were commoner in the former. Children with purulent meningitis had a significantly shorter duration of symptoms than children without meningitis. The present study could not suggest any ways of improving the referral procedures.