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Time to lumbar puncture: can we do any better?
  1. Samantha Lissauer,
  2. Andrew Riordan
  1. Paediatric Infectious Disease and Immunology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Samantha Lissauer, Paediatric Infectious Disease and Immunology, Alder Hey Children’s Hospital, Liverpool L12 2AP, UK; samantha.lissauer{at}alderhey.nhs.uk

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Introduction

Everybody would agree that treating children with bacterial meningitis promptly is a good thing. However, there is little data on how promptly antibiotic treatment should be given. Children with the rash of meningococcal disease can be given antibiotics within an hour of presentation. Suggesting the same target for children with bacterial meningitis is probably over simplistic, not evidence based and has not been reported in any study over the past 25 years. To achieve this would require a fundamental change in the way children with possible meningitis are assessed. What does a paediatric trainee think of this suggestion?

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Recognising cases of acute bacterial meningitis in children of all ages is crucially important in order to ensure prompt effective treatment and thus optimise outcome.1 The primary investigation for children with suspected meningitis is a lumbar puncture (LP)2; however, these can often be delayed, particularly if the child is unwell or if there is diagnostic uncertainty. Ramasamy et al 3 looked at a large cohort of children who were being investigated for meningitis, in order to quantify the time to investigation and treatment. They studied time to LP, time to antibiotic treatment and length of hospital stay in children presenting to three large paediatric centres in the UK.

Overall results showed that median time from initial hospital assessment for possible meningitis to LP was 4.8 hours for all age groups (3 hours when LP times were documented accurately). Many children had also been seen prehospital, mostly by a general practitioner, although the authors did not make attempts to include this in their time to …

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