Ramasamy, R; Willis, L; Kadambari, S; Kelly, DF; Heath, PT; Nadel, S; Pollard, AJ; Sadarangani, M
(2018)
Management of suspected paediatric meningitis: a multicentre prospective cohort study.
Arch Dis Child, 103 (12).
pp. 1114-1118.
ISSN 1468-2044
https://doi.org/10.1136/archdischild-2017-313913
SGUL Authors: Heath, Paul Trafford
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Abstract
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.
Item Type: | Article | ||||||||
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Additional Information: | This article has been accepted for publication in Archives of Disease in Childhood following peer review. The definitive copyedited, typeset version Ramasamy R, Willis L, Kadambari S, et al Management of suspected paediatric meningitis: a multicentre prospective cohort study Archives of Disease in Childhood 2018;103:1114-1118 is available online at: http://dx.doi.org/10.1136/archdischild-2017-313913 | ||||||||
Keywords: | antibiotics, delay, lumbar puncture, meningitis, polymerase chain reaction, antibiotics, delay, lumbar puncture, meningitis, polymerase chain reaction, Pediatrics, 1103 Clinical Sciences, 1114 Paediatrics And Reproductive Medicine, 1117 Public Health And Health Services | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Infection and Immunity Research Institute (INII) | ||||||||
Journal or Publication Title: | Arch Dis Child | ||||||||
ISSN: | 1468-2044 | ||||||||
Language: | eng | ||||||||
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Publisher License: | Publisher's own licence | ||||||||
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PubMed ID: | 29436406 | ||||||||
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URI: | https://openaccess.sgul.ac.uk/id/eprint/109792 | ||||||||
Publisher's version: | https://doi.org/10.1136/archdischild-2017-313913 |
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