Data from: Assessment of healthcare delivery in the early management of bacterial meningitis in UK young infants: an observational study

OBJECTIVE: To define early presenting features of bacterial meningitis in young infants in England and to review the adequacy of individual case management as compared with relevant national guidelines and an expert panel review. DESIGN: Retrospective medical case note review and parental recall using standardised questionnaires. SETTING: England and Wales. PARTICIPANTS: Infants aged <90 days with bacterial meningitis diagnosed between July 2010 and July 2013. RESULTS: Of the 97 cases recruited across England and Wales, 66 (68%) were admitted from home and 31 (32%) were in hospital prior to disease onset. Almost all symptoms reported by parents appeared at the onset of the illness, with very few new symptoms appearing subsequently. Overall, 20/66 (30%) infants were assessed to have received inappropriate pre hospital management. The median time from onset of first symptoms to first help was 5 hours (IQR: 2-12) and from triage to receipt of first antibiotic dose was 2.0 hours (IQR: 1.0-3.3) hours, significantly shorter in infants with fever or seizures at presentation compared to those without (1.7 [IQR, 1.0-3.0] vs. 4.2 [1.8-6.3] hours, p=0.02). Overall, 26 (39%) infants had a poor outcome in terms of death or neurological complication; seizures at presentation was the only significant independent risk factor (OR, 7.9; 95% CI: 2.3- 207.0). For cases in hospital already, the median time from onset to first dose of antibiotics was 2.6 (IQR: 1.3-9.8) hours and 12/31 (39%) of infants had serious neurological sequelae at hospital discharge. CONCLUSIONS: Young infants with bacterial meningitis have non-specific symptoms and signs, with no clear progression of illness over time, highlighting the difficulties in early recognition by parents and healthcare professionals alike. A substantial proportion of infants received inappropriate pre- and post-hospital management. We propose a targeted campaign for education and harmonisation of practice with evidence-based management algorithms.

研究目的：明确英格兰地区低龄婴儿细菌性脑膜炎（bacterial meningitis）的早期首发临床表现，并对照国家相关临床指南及专家小组评估结果，审查个体病例诊疗措施的合理性。
研究设计：采用回顾性病历审查结合家长回忆的标准化问卷调研方法。
研究场景：英格兰及威尔士地区。
研究对象：2010年7月至2013年7月期间确诊细菌性脑膜炎、年龄<90日龄的婴儿。
研究结果：本次研究共纳入英格兰及威尔士地区97例病例，其中66例（68%）从家中入院，31例（32%）在发病前已处于住院状态。家长报告的几乎所有症状均在疾病发作初期出现，后续新增症状极少。总体而言，66例院外入院患儿中有20例（30%）被评估为接受了不恰当的院前诊疗。从首发症状出现至首次寻求医疗帮助的中位时间为5小时（四分位距IQR：2~12），从分诊至首次给予抗菌药物的中位时间为2.0小时（IQR：1.0~3.3）；其中以发热或惊厥起病的患儿，该时间显著短于无此类症状的患儿（1.7 [IQR, 1.0~3.0] vs. 4.2 [1.8~6.3] 小时，p=0.02）。总体而言，26例（39%）患儿出现死亡或神经系统并发症等不良预后；以惊厥起病是唯一具有统计学意义的独立危险因素（比值比OR：7.9；95%置信区间CI：2.3~207.0）。对于已住院的病例，从发病至首次给予抗菌药物的中位时间为2.6小时（IQR：1.3~9.8），31例患儿中有12例（39%）在出院时存在严重神经系统后遗症。
研究结论：低龄细菌性脑膜炎婴儿的症状与体征均缺乏特异性，且随时间推移无明确的病情进展，这凸显了家长及医护人员早期识别该病的难度。相当比例的患儿接受了不恰当的院前及院内诊疗。我们建议开展针对性宣教活动，并统一临床实践标准，推广基于证据的诊疗算法。