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Prospective study of "door to needle time" in meningococcal disease
F A Riordan1, A P Thomson, J A Sills
1Institute of Child Health, University of Liverpool.
Insights
Prompt antibiotic treatment for pediatric meningococcal disease is crucial. Most children received antibiotics in the emergency department within a median of 36 minutes, especially those with severe symptoms or a rash.
Area of Science:
- Pediatric infectious diseases
- Clinical pharmacology
- Emergency medicine
Background:
- Meningococcal disease poses a significant threat to children.
- Timely antibiotic administration is critical for improving outcomes in pediatric meningococcal disease.
Purpose of the Study:
- To evaluate the promptness of parenteral antibiotic administration in children diagnosed with meningococcal disease.
- To identify factors influencing the time to antibiotic treatment.
Main Methods:
- Prospective data collection of "door to needle time" for parenteral antibiotics in 100 children with meningococcal disease.
- Study conducted across four hospitals in Merseyside, including children aged 3-168 months.
- Analysis of treatment times based on presentation route (direct to A&E vs. GP referral) and clinical signs (e.g., petechial rash).
Main Results:
- Median "door to needle time" was 36 minutes.
- Children with a petechial rash received antibiotics within 60 minutes.
- Antibiotic administration was significantly faster in severe cases (p=0.01) and slower in non-rash presentations (p=0.007).
Conclusions:
- The majority of children with meningococcal disease received their first dose of parenteral antibiotics in the Accident and Emergency (A&E) department.
- Heightened awareness and ongoing research improve treatment times for children with a petechial rash.
- Educational strategies for both A&E staff and General Practitioners (GPs) are recommended to further enhance immediate treatment protocols.
Objective:
To measure the promptness of antibiotic treatment in children with meningococcal disease.
Methods:
"Door to needle time" for parenteral antibiotics in children with meningococcal disease was recorded prospectively as part of a larger study. The time from arrival at hospital until the first dose of parenteral antibiotics was recorded in 100 children with meningococcal disease (median (range) age 21 (3-168) months) admitted to four Merseyside hospitals.
Results:
Forty five children presented directly to the accident and emergency (A&E) department. Parenteral penicillin was given before admission to 19 of the 55 children referred by general practitioners (GPs). Median door to needle time was 36 minutes. All children with a typical petechial rash on arrival received antibiotics within 60 minutes. Antibiotics were given sooner to those with severe disease (p = 0.01) and later to those without a rash (p = 0.007).
Conclusions:
The first dose of parenteral antibiotics for most children with meningococcal disease was given in A&E. When awareness of meningococcal disease is heightened by ongoing research, those with a petechial rash are treated within 60 minutes. Strategies to improve immediate treatment of meningococcal disease should include education of A&E staff as well as GPs.
