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Patients waiting 29 hours for meningitis diagnosis

Monday July 2nd, 2018

There are delays of more than 29 hours in undertaking diagnostic testing in some cases of suspected bacterial meningitis, according to new research.

An observational study, published in The Lancet Infectious Diseases, has found substantial delays in diagnostic testing and unnecessary treatment in hospitals across England, with the median time from admission to a lumbar puncture to distinguish between bacterial and viral meningitis being 17 hours. However, in a quarter of patients it took more than 29 hours.

International guidelines say a lumber puncture must be carried out to rule out bacterial meningitis and reduce unnecessary antibiotic treatment, shorten hospital stays, and lessen healthcare costs. However, this testing is often delayed, leading to difficulties in making a diagnosis.

Lead researcher Dr Fiona McGill, from the Institute of Infection and Global Health at the University of Liverpool, UK, said: “It’s possible that the four-hour accident and emergency treatment target is creating unintended pressure, leading to key investigations like lumbar puncture being postponed until patients have been admitted to a ward. Additional delays of several days can also occur if samples are sent to offsite laboratories for analysis.”

The introduction of conjugate vaccines in the 1990s has led to a decline in bacterial meningitis across England, although viral meningitis is now increasing.

The study included 1113 patients with suspected meningitis attending 42 hospitals in England between September 2011 and September 2014.

All participants either had a lumbar puncture or a bacterial or viral pathogen identified in their blood test or culture. The researchers examined the association between time to lumbar puncture and receiving a microbiologically proven diagnosis.

More than half – 638 – were diagnosed with meningitis, of which 231 were caused by a virus. A further 99 cases (16%) were bacterial, while 267 (42%) had an unknown cause. 41 cases (6%) had other causes identified.

Results showed that unnecessary treatment with antivirals was associated with longer hospital stays – with patients infected with viral meningitis who did not have treatment staying for an average of 3 days compared with 9 days in those treated with antivirals.

There was also evidence that earlier lumbar puncture led to more patients having a specific cause identified than those in whom testing was delayed.

“Improved rapid diagnostic testing so that more patients can have a specific cause determined quickly could reduce unnecessary use of antimicrobials (i.e., both antibiotics and antivirals) and therefore reduce hospital stays and other investigations,” added the authors.

McGill, F, Griffiths M, Bonnett L et al. Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study. The Lancet Infectious Diseases 29 June 2018; doi:10.1016/S1473-3099(18)30245-7

www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30245-7/fulltext

Tags: A&E | Brain & Neurology | Child Health | NHS | UK News

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