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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.
- meningitis
- lumbar puncture
- antibiotics
- polymerase chain reaction
- delay
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Footnotes
Contributors RR analysed the data and wrote the initial draft of the manuscript. LW was responsible for study design and data collection. SK was responsible for data collection. DKF, PTH, SN, AJP and MS conceived and designed the study. All authors critically appraised the manuscript and approved the final version.
Funding This work was supported by Pfizer through an investigator-initiated research award (grant number WS907044) and supported by the Oxford Partnership Comprehensive Biomedical Research Centre with funding from the Department of Health’s National Institute of Health Research Biomedical Research Centres funding scheme. AJP is a Jenner Institute Investigator and James Martin Senior Fellow. DFK receives salary support from the Oxford NIHR Biomedical Research Centre. The organisations funding this study had no role in the study design; in the collection, analysis and interpretation of the data; in the writing of the report and in the decision to submit the article for publication.
Competing interests SK has received support to attend scientific meetings from GlaxoSmithKline. DFK has received research funding from GlaxoSmithKline and received support from GlaxoSmithKline and Sanofi-Pasteur to attend scientific meetings. PTH received a grant from Pfizer towards the submitted work. He is also an investigator for clinical trials done on behalf of St George’s, University of London, UK, sponsored by vaccine manufacturers and has been a consultant to Novartis and Pfizer on Group B Streptococcus vaccines, but received no payments for this. SN has acted as a consultant to Novartis Vaccines on serogroup B meningococcal vaccine and has received honoraria from Novartis and Pfizer for consultancy work paid into an educational and administrative fund. MS has received grants from Pfizer outside of the submitted work. AJP has received grants from Novartis, Pfizer and Okairos, outside of the submitted work. His department received unrestricted educational grants from Pfizer, GSK and Astra Zeneca in July 2016 for a course on Infection and Immunity in Children. AJP has previously conducted clinical trials of meningococcal meningitis vaccines on behalf of the University of Oxford, funded by vaccine manufacturers, but no longer does so and he received no personal payments from them. AJP is chair of the UK Department of Health’s Joint Committee on Vaccines and Immunisation, chair of the European Medicine Agency’s Scientific Advisory Group on Vaccines and a member of the WHO’s SAGE. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health, the EMA, or the WHO.
Ethics approval Oxfordshire B Research Ethics Committee (Ref: 11/H0605/11).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Full data set is available on request from the corresponding author. Consent was not obtained for data sharing but the presented data are anonymised and the risk of identification is low.