Most adults with community-acquired bacterial meningitis or meningococcal septicaemia are seen by junior doctors who have limited experience of these conditions. Yet early recognition, assessment of disease severity, and the introduction of specific therapy are crucial.
In order to identify strategies to improve the outcome, researchers from the University of Bristol and the Health Protection Agency, along with clinical and public health experts, conducted an audit to assess current clinical practice in England and Wales and evaluate the quality of care. The audit was commissioned by Sir Liam Donaldson, Chief Medical Officer.
They found compliance with standards based on those of the British Infection Society was not widely achieved in a number of key areas, including prompt assessment and initiation of treatment, adequate disease severity assessment and timely prevention of secondary cases. The absence of a consistent approach to the management of meningitis was reflected in considerable variation in the quality of care between hospitals in relation to "best practice".
The authors recommend that patients with suspected bacterial meningitis and meningococcal septicaemia have a comprehensive clinical assessment as a matter of urgency, and commence resuscitation and antibiotic therapy within one hour of presentation, as individuals who appear relatively well may deteriorate rapidly without warning. Ideally, a senior member of the clinical team should assess patients, again as a matter of urgency. Clinical records should clearly and accurately document all information essential to management, including assessment of disease severity.
The findings also suggest a need for specific training in the diagnosis and management of suspected bacterial meningitis and other severe infections. The researchers recommend that competency standards developed to assess the training of junior doctors should include the management of these infections. They suggest that consensus guidelines on management of meningitis be promoted using interventions such as educational materials and local audits to help improve compliance.
Rob Heyderman, co-author of the study and the David Baum Professor of Infectious Diseases and International Health in the Department of Cellular and Molecular Medicine at Bristol University, said: "This is the first national study to evaluate the quality of care in adults with bacterial meningitis and meningococcal septicaemia. Results from the study show that the quality of care can be improved.
"This study provides a tool for developing targeted interventions to improve quality of care and outcome among adults with life-threatening infections, both in the UK and in other countries."
"Recognition of meningococcal disease is often difficult, particularly in adults," said Sir Liam Donaldson. "Every year, a small number of cases are missed by clinicians. This study highlights the importance of early recognition, assessment of disease severity, and the introduction of specific therapy. I will be considering the recommendations made in this report to determine how we can further improve clinical management of adults with meningococcal disease."