UBC Faculty Research and Publications

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


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.

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