Delays in Diagnosis and Treatment of Bacterial Meningitis in NYC: Retrospective Cohort Analysis

Abstract

Community-acquired bacterial meningitis (CABM) morbidity and mortality remains high in those infected. Rapid diagnosis and treatment is paramount to reducing mortality and improving outcome. This retrospective cohort study aims to assess the time from presentation to diagnosis and treatment of vaccine preventable CABM as well as identify possible factors associated with delays in diagnosis and antibiotic administration. A retrospective chart review was conducted of individuals who presented to Columbia University Irving Medical Center (CUIMC), Children’s Hospital of New York (CHONY), Mount Sinai Medical Center, and Weill Cornell Medical Center with BM due to Haemophilus influenzae type B, Streptococcus pneumoniae, and Neisseria meningitidis between January 1, 2012 and December 31, 2017. Diagnosis was delayed by more than 8 hours in 13 patients (36.1%) and 5 individuals (13.9%) had a delay of 4 hours or more from presentation to the administration of antibiotics with appropriate CNS coverage. All of these patients were also initially misdiagnosed at an outpatient clinic, outside hospital, or emergency department. This retrospective study identified febrile and/or viral infections not otherwise specified and otitis media as the most common misdiagnoses underlying delays from presentation to diagnosis and to antibiotic treatment in those with BM.

Shifts in Diagnostic Testing for Headache in the Emergency Department, 2015 to 2021

“…We also observed that 5% of SAH and 18% of bacterial meningitis cases were possibly misdiagnosed at index ED visits, estimates which are consistent with prior literature . Although we did not observe a significant change in the proportion of missed diagnoses over time, the small number of cases limited detection of differences.…”

A Reduction in the Number of Hospitalized Cases of Acute Meningitis during the COVID-19 Pandemic in Japan

“…Another conceivable theory is an underdiagnosis among the younger population due to refraining from visiting hospitals during the pandemic, especially among those with mild and self-remitting symptoms of viral meningitis. An underdiagnosis of cases of acute meningitis, if present, could thus be considered to be a negative aspect associated with the pandemic, as a delayed lumbar puncture was shown to be associated with increased medical costs and higher mortality rates (20,21). Therefore, both the actual decrease in the prevalence of acute meningitis and possible underdiagnosis due to refraining from visiting hospitals among mild cases could have contributed to the dramatic decrease in the number of hospitalized cases of acute meningitis during the pandemic.…”

Can Clinical Presentations or Hematological Indices Predict Meningitis in Febrile Children?

“…Adding to this problem is that obtaining CSF analysis by lumbar puncture in children is dependent on parental approval with high refusal rates documented in Iraq [6]; this together with the lack of confirmation of cases of meningitis has led to underreporting of the cases in Iraq [5]. Meningitis is prevalent in the pediatric age group and undiagnosed cases or delays in the diagnosis can lead to a high mortality rate [7][8][9]. This all calls for a need to find a constellation of clinical presentations and hematological indices to serve as a diagnostic tool or at least for screening febrile children during meningitis outbreaks for early case identification and management.…”