THE EFFECT OF A RECENT PREVIOUS VISIT TO A PHYSICIAN ON OUTCOME AFTERCHILDHOOD BACTERIAL-MENINGITIS

Objective.-To assess the effect of a recent previous visit to a physic ian on the outcome of meningitis in children. Design.-Evaluation of da ta from children examined by a physician and sent home, either the pre vious day or 2 to 4 days before meningitis was diagnosed, and children whose meningitis was diagnosed at once. The patients were examined da ily during hospitalization, neurologic examinations were repeated at 2 weeks and 3 and 6 months after discharge, and hearing was assessed 2 or more months after discharge. Setting.-Eighteen pediatric hospitals in Finland from 1984 through 1991. Population.-A total of 325 children aged 3 months to 15 years with bacterial meningitis. Main Outcome Mea sures.-Clinical and laboratory findings on admission, recovery during hospitalization, mortality, and neurologic abnormalities at 6 months o f follow-up. Results.-In 74% of the patients, meningitis was diagnosed at once, 14% had visited a physician on the previous day, and 11% had seen a physician 2 to 4 days before diagnosis. The group seen 2 to 4 days earlier had a better level of consciousness, less frequent seizur es, and more respiratory symptoms and otitis media than the other grou ps. The cerebrospinal fluid leukocyte count, white blood cell count, a nd erythrocyte sedimentation rate were highest and the cerebrospinal f luid glucose concentration was lowest in the children who had visited a physician 2 to 4 days earlier; although they also had lower cerebros pinal fluid protein and urine sodium and potassium levels. This group had the most rapid return to normal consciousness. There was no differ ence in the incidence of hearing impairment or neurologic sequelae. Ev en the mortality was virtually the same in the three groups: 4%, 4%, a nd 3% in the ''same day,'' ''previous day,'' and ''2 to 4 days earlier '' groups, respectively. Conclusions.-Children who had visited a physi cian the previous day or 2 to 4 days before meningitis was diagnosed d id not exhibit an increased frequency of hearing impairment, other neu rologic abnormalities, or overall adverse outcome compared with childr en whose meningitis was diagnosed at once.