Avoidable deficiencies in the delivery of health care to children with meningococcal disease.

Abstract

Objectives-It is apparent that delays and inadequate or inappropriate management occur frequently and may contribute to the continued high mortality seen in meningococcal disease. An attempt has been made to define the major sources of delay or inappropriate treatment. Methods-A prospective, descriptive study of children with meningococcal disease referred to a tertiary centre paediatric intensive care and infectious disease unit. Definitions of optimal care were established at three stages: parental; general practitioner (GP)/accident and emergency (A&E) department; and hospital. Duration of symptoms and management were recorded from direct questioning of parents and carers, and from hospital records.

Etiology of Childhood Bacteremia and Timely Antibiotics Administration in the Emergency Department

“…5 Timely, effective antimicrobial therapy is fundamental to the management of serious infections in children. Delayed recognition of meningococcal disease, 6 and suboptimal resuscitation of septic shock, contribute to mortality in children. 7,8 The Surviving Sepsis Campaign recommends administration of antibiotics within 1 hour of recognition of severe sepsis.…”

Using vital signs to assess children with acute infections: a survey of current practice

“…However, children with serious bacterial infections are sometimes misdiagnosed in primary care; up to 50% of children with meningococcal disease were missed at first consultation with GPs. [3][4][5] The clinical methods that GPs use to identify children with serious bacterial infection have been described in qualitative studies. [6][7][8] A feeling that 'something is wrong' is a useful discriminating factor in children presenting to primary care with acute infection.…”

Systems for Pediatric Sepsis: A Global Survey

“…Previous studies show that prompt recognition and treatment in the community confers a significant survival benefit (25,26,28). There is limited research regarding the profile of patients who present at peripheral compared to tertiary care sites.…”

“…Parents can be taught to recognize the sensitive signs of sick children and alert health-workers. In the United Kingdom, researchers from the Paediatric Intensive Care Society and the Meningitis Research Foundation conducted a successful campaign directed at parents to identify early signs of meningococcaemia, including petechiae and purpura (28). This was thought to be an important factor in improving outcomes for children with this condition (29,30).…”