In November 2000, we published an article “Accessing electronic information for clinical decisions” (Arch Dis Child2000;83:373–4) which began:

The setting: It's early on a Friday evening, and you're working as registrar in A&E. A 6 year old girl is rushed in as an emergency, complaining of headache; she is febrile with convincing nuchal rigidity. Your colleague performs a lumbar puncture, then you attempt to achieve intravenous access, and by the time the anaesthetic cream has cooked the microbiologist rings from the lab. The CSF contains 50 polymorphs, two red cells, and is “teeming with Gram positive diplococci”.The question: Before you give an antibiotic though, you wonder about the steroids in meningitis debate. Should this girl get dexamethasone prior to antibiotics? Will it reduce her chance of hearing loss—or just increase her chance of continued infection? You reckon the five minutes it will take to draw up the antibiotic is enough time to try to find some information to help.

In that first article the registrar went on to access a number of databases before concluding that the addition of steroids would be best. One of our readers wondered if the story might not, in the real world, have developed a little differently.