The Effect of a Recent Previous Visit to a Physician on Outcome After Childhood Bacterial Meningitis

Kallio, Markku; Kilpi, Terhi; Anttila, Marja; Peltola, Heikki

doi:10.1001/jama.1994.03520100049032

Cited by 27 publications

(5 citation statements)

References 29 publications

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“…25 26 The main contribution to outcome was postulated to be the severity of disease, with slowly evolving cases more likely to be diagnosed late. 25 26 We found that delayed hospital admission did not predict the combined variable of death or severe neurological sequelae. However, when deaths were excluded, delayed hospitalisation significantly predicted morbidity in survivors.…”

Section: Discussionmentioning

confidence: 70%

A population based study of the impact of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis

McIntyre

2005

Archives of Disease in Childhood

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Background: Despite an extensive literature, the impact of both adjunctive steroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis is controversial. Aim: To determine the independent contribution of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis in a representative population with good access to medical services. Methods: Data were obtained from laboratories and hospital records to assemble a population register in Sydney, Australia, 1994-99. Follow up questionnaires were completed by attending physicians. Results: A total of 122 cases of pneumococcal meningitis aged 0-14 years were identified. Almost 50% of 120 children with available records either died (n = 15) or had permanent neurological impairment (n = 39). Early use (before or with parenteral antibiotics) of corticosteroids protected against death or severe morbidity (adjusted OR 0.21, 95% CI 0.05 to 0.77). Delayed diagnosis was associated with increased morbidity in survivors (OR 3.4, 95% CI 1.03 to 11.4) but not with increased mortality. Conclusion: In a population with good access to health care and after adjusting for other known prognostic variables, early recognition of pneumococcal meningitis and treatment with adjunctive dexamethasone significantly improves outcomes. These data add to those from randomised controlled trials. Implementation requires development of protocols and guidelines for use in emergency departments.

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Section: Discussionmentioning

confidence: 70%

A population based study of the impact of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis

McIntyre

2005

Archives of Disease in Childhood

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“…It has been reported that between one-quarter and one-half of all children who develop ABM have visited a clinician prior to having ABM diagnosed [8,9]. In our study, 45% of young children sought care from a clinician prior to the diagnosis of meningitis, and 64% of the children who visited a clinician did so within 24 h of the onset of fever.…”

Section: Discussionmentioning

confidence: 59%

“…Kallio et al [8] reported that between 44% and 58% of patients had received prior antibiotic treatment, depending on the length of time between the last contact with a clinician and the visit at which a diagnosis of meningitis was made. Other studies have reported a total rate of antibiotic use (not restricted to patients who visit a clinician) of up to 40% of patients.…”

Section: Discussionmentioning

confidence: 99%

Fever Interval before Diagnosis, Prior Antibiotic Treatment, and Clinical Outcome for Young Children with Bacterial Meningitis

Bonsu

Harper

2001

Clinical Infectious Diseases

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In young children, meningitis due to Streptococcus pneumoniae is preceded by a long interval from onset of fever to diagnosis of bacterial meningitis (hereafter known as "fever interval"), during which time the patient frequently contacts a clinician. By means of retrospective chart review, we compared the fever interval that preceded diagnosis with the complication rate among 288 young children (age, 3--36 months) who had bacterial meningitis (1984--1996), as stratified by causative organism and prior antibiotic treatment. Pathogens included S. pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis. Pneumococcus species were associated with the longest fever interval prior to diagnosis of meningitis, the highest frequency of contact with a clinician before hospitalization, and the highest rate of documented morbidity or mortality. For S. pneumoniae, there was an association between antibiotic treatment received at prior meetings with a clinician and a reduced rate of meningitis-related complications (odds ratio, 0.14; P=.02). Antibiotic treatment during such meetings is associated with a substantial reduction in disease-related sequelae.

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“…Mortality of patients presenting with meningococcal meningitis is low (1%–5%), considerably lower than that of patients with invasive meningococcal disease without meningitis (up to 40%). Furthermore, prognosis of patients with bacterial meningitis (from all causes) was no worse in those whose disease was not recognised for as long as two to four days before admission than in those admitted when first seen 7 …”

Section: Syndromes Of Meningococcal Diseasementioning

confidence: 99%

Early clinical clues to meningococcaemia

Yung

McDonald

2003

Medical Journal of Australia

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Meningococcal septicaemia has high mortality, especially when the diagnosis is delayed or missed. Early recognition is not always straightforward, as classic clinical features may be absent or overlooked at initial presentation. Septicaemia without focal infection accounts for 15%–20% of cases of meningococcal disease and is the most worrisome manifestation in terms of diagnosis and outcome; in contrast, meningococcal meningitis is usually straightforward to diagnose, with a relatively good prognosis. Useful early clinical clues to meningococcaemia include:  – a haemorrhagic (petechial or purpuric) rash;  – blanching macular or maculopapular rash that appears in first 24 hours of illness;  – true rigors;  – severe pain in extremities, neck or back; vomiting, especially in association with headache or abdominal pain; rapid evolution of the illness;  – concern of parents, relatives or friends;  – patient age (highest incidence at age 3–12 months, followed by 1–4 and then 15–19 years); and  – contact with a patient with meningococcal disease. In addition to specific clues, clinicians should look at the whole pattern of the illness. Timely clinical review is essential if there is doubt about the diagnosis. In any acutely febrile patient, it is prudent to ask “Why is this patient seeking help now?”, then “Could this patient have meningococcaemia?”.

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The Effect of a Recent Previous Visit to a Physician on Outcome After Childhood Bacterial Meningitis

Abstract: Children who had visited a physician the previous day or 2 to 4 days before meningitis was diagnosed did not exhibit an increased frequency of hearing impairment, other neurologic abnormalities, or overall adverse outcome compared with children whose meningitis was diagnosed at once.

Cited by 27 publications

References 29 publications

A population based study of the impact of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis

A population based study of the impact of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis

Fever Interval before Diagnosis, Prior Antibiotic Treatment, and Clinical Outcome for Young Children with Bacterial Meningitis

Early clinical clues to meningococcaemia

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