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Recognising meningococcal disease in primary care: qualitative study of how general practitioners process clinical and contextual information

Abstract Objectives: To describe the presentation of meningococcal disease in primary care; to explore how general practitioners process clinical and contextual information in children with meningococcal disease; and to describe how this information affects management. Design: Qualitative analysis o...

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Bibliographic Details
Published in:BMJ 1998-01, Vol.316 (7127), p.276-279
Main Authors: Granier, Stephen, Owen, Penny, Pill, Roisin, Jacobson, Lionel
Format: Article
Language:English
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Summary:Abstract Objectives: To describe the presentation of meningococcal disease in primary care; to explore how general practitioners process clinical and contextual information in children with meningococcal disease; and to describe how this information affects management. Design: Qualitative analysis of semistructured interviews. Setting: General practices in South Glamorgan. Subjects: 26 general practitioners who between January 1994 and December 1996 admitted 31 children (under 16 years of age) in whom meningococcal disease was diagnosed. Main outcome measures: Categories of clinical rules and techniques used by general practitioners in processing each case. Results: 22 children had rashes; in 16 of them the rashes were non-blanching. When present, a haemorrhagic rash was the most important factor in the doctor's decision to admit a child. 22 children had clinical features not normally expected in children with acute self limiting illnesses—for example, lethargy, poor eye contact, altered mental states, pallor with a high temperature, and an abnormal cry. Contextual information, such as knowledge of parents' consultation patterns and their normal degree of anxiety, played an important part in the management decisions in 15 cases. Use of penicillin was associated with the certainty of diagnosis and the presence and type of haemorrhagic rash. Conclusion: The key clinical feature of meningococcal disease—a haemorrhagic rash—was present in only half of the study children. The general practitioners specifically hunted for the rash in some ill children, but doctors should not be deterred from diagnosing meningococcal disease and starting antibiotic treatment if the child is otherwise well, if the rash has an unusual or scanty distribution, or if the rash is non-haemorrhagic. Key messages In primary care the main emphasis in managing meningococcal disease in children is early recognition and initiation of antibiotic treatment In this study of 26 general practitioners admitting 31 children with meningococcal disease, a haemorrhagic rash was the most important single factor leading to admission but was present in only half of the children When a haemorrhagic rash is present general practitioners should not be deterred from diagnosing meningococcal disease and starting antibiotic treatment if the child is otherwise well or if the rash is scanty or has an unusual distribution The general practitioners noted abnormal illnesses with features different from those of acut
ISSN:0959-8138
0959-8146
1468-5833
1756-1833
DOI:10.1136/bmj.316.7127.276