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Management of suspected paediatric meningitis : a multicentre prospective cohort study Ramasamy, Roshan; Willis, Louise; Kadambari, Seilesh; Kelly, Dominic F.; Heath, Paul T.; Nadel, Simon; Pollard, Andrew J.; Sadarangani, Manish

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 pre-hospital and in-hospital assessments, LP, antibiotic treatment and discharge; types of pre-hospital medical assessment and microbiological results. Data collected from hospital records and parental interview. Results: 220/388 (57%) children were seen by a medical professional pre- hospitalisation (143 by a GP). 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, 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 under-used despite national recommendations. These deficiencies reduce the ability to exclude bacterial meningitis, increasing unnecessary hospital stay and antibiotic treatment.

Item Metadata

Title
Management of suspected paediatric meningitis : a multicentre prospective cohort study
Creator
Ramasamy, Roshan; Willis, Louise; Kadambari, Seilesh; Kelly, Dominic F.; Heath, Paul T.; Nadel, Simon; Pollard, Andrew J.; Sadarangani, Manish
Contributor
Children's Hospital (Vancouver, B.C.). Vaccine Evaluation Center; Children's Hospital (Vancouver, B.C.). Research Institute.
Publisher
BMJ
Date Issued
2018-02-07
Description
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 pre-hospital and in-hospital assessments, LP, antibiotic treatment and discharge; types of pre-hospital medical assessment and microbiological results. Data collected from hospital records and parental interview. Results: 220/388 (57%) children were seen by a medical professional pre- hospitalisation (143 by a GP). 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, 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 under-used despite national recommendations. These deficiencies reduce the ability to exclude bacterial meningitis, increasing unnecessary hospital stay and antibiotic treatment.
Genre
Article; Postprint
Type
Text
Language
eng
Date Available
2023-09-01
Provider
Vancouver : University of British Columbia Library
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
DOI
10.14288/1.0435716
URI
http://hdl.handle.net/2429/85764
Affiliation
Medicine, Faculty of; Non UBC; Pediatrics, Department of
Citation
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.
Publisher DOI
10.1136/archdischild-2017-313913
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher
Rights URI
http://creativecommons.org/licenses/by-nc-nd/4.0/
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Attribution-NonCommercial-NoDerivatives 4.0 International