Management of patients with suspected meningitis or meningoencephalitis. Are we compliant with guidelines?

• Published in: Journal of emergency medicine, trauma & acute care trauma & acute care, 2016-10, Vol.2016 (2)
• Main Authors: Zahid, Muhammad, Ahmed, Khalid Mohamed, Salameh, Sarah, Mushtaq, Kamran, Athreya, Akshay, Al-Mohanadi, Dabia Hamad S H, Al-Mohammad, Ahmed Ali A A
• Format: Article
• Language: English
• ISSN: 1999-7086; 1999-7094
• DOI: 10.5339/jemtac.2016.icepq.51

Background: Central Nervous system infections are associated with high morbidity and mortality. Initial presentation can be very non-specific, the classic triad of: fever, headache and altered mental status only found in 44% of patients with acute bacterial meningitis. In a recent study a delay in antimicrobial treatment of more than three hours after hospital admission was a strong and independent risk factor for mortality. Methods: We reviewed case notes of patients presented with suspected meningitis or meningoencephalitis. We designed a Performa to collect information on presentation, clinical findings, investigation and management of these patients. Results: 30 case notes were reviewed. 16 out of 30 patients had at-least 2 out of 3 classic features. Skin rash was not looked for in 53% patients. 83% patients had no documentation regarding presence or absence of papilledema. 75% of patients appropriately had CT Brain done before LP. 56% of patients had appropriate antibiotics in less than 3 hours. Mean time to perform LP was 10.38 hours. No patients had steroids before or along with antibiotics. One patient had CSF opening pressure checked on lumber puncture. In 10 patients paired serum sample was sent for glucose. Conclusion: Major deficiencies are noted in documentation of key symptoms, signs investigations and management for CNS infection. We have planned three major interventions: 1) Senior physician review of all patients suspected of CNS infection within one hour. 2) All patients suspected of CNS infection have appropriate antibiotics administered within three hours of presentation. Steroids should be given along with first dose of antibiotic where indicated. 3) Implement LP sticker to improve documentation We will run few PDSA cycles of suggested interventions and study the results. Recommendations will be made based on PDSA results.