AVOIDABLE DEFICIENCIES IN THE DELIVERY OF HEALTH-CARE TO CHILDREN WITH MENINGOCOCCAL DISEASE

Objectives-It is apparent that delays and inadequate or inappropriate management occur frequently and may contribute to the continued high m ortality seen in meningococcal disease. An attempt has been made to de fine the major sources of delay or inappropriate treatment. Methods-A prospective, descriptive study of children with meningococcal disease referred to a tertiary centre paediatric intensive care and infectious disease unit. Definitions of optimal care were established at three s tages: parental; general practitioner (GP)/accident and emergency (A&E ) department; and hospital. Duration of symptoms and management were r ecorded from direct questioning of parents and carers, and from hospit al records. Results-54 consecutive children with meningococcal disease were recruited to the study. Delayed parental recognition occurred in 16 children. GPs correctly diagnosed 19 of 35 children. Delay of 2.5- 21 hours occurred in those who were incorrectly diagnosed. Two of 15 c hildren who presented to the A&E department with specific features wer e incorrectly diagnosed. Hospital treatment was suboptimal in 71%. Sho ck was not recognised or treated in 50%, 20% of children had unnecessa ry lumbar punctures. Time from illness onset to treatment was longer i n fatal disease (median 18.3, range 8-24 hours), compared with survivo rs (median 12, range 2-48 hours; p<0.01, Mann-Whitney U test). Conclus ion-Suboptimal treatment in meningococcal disease is due to failure of parents, GPs, and hospital doctors to recognise specific features of the illness. Improvement in outcome could be achieved by public educat ion and better training of clinicians in recognition, resuscitation, a nd stabilisation of seriously ill children.