Determinants of timely management of acute bacterial meningitis in the ED

Schuh, Sabine; Lindner, Gregor; Exadaktylos, Aristomenis K.; Mühlemann, Kathrin; Täuber, Martin G. (2013). Determinants of timely management of acute bacterial meningitis in the ED. American journal of emergency medicine, 31(7), pp. 1056-1061. Philadelphia, Pa.: W.B. Saunders 10.1016/j.ajem.2013.03.042

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PURPOSE: The purpose was to study the emergency management of patients with suspected meningitis to identify potential areas for improvement. METHODS: All patients who underwent cerebrospinal fluid puncture at the emergency department of the University Hospital of Bern from January 31, 2004, to October 30, 2008, were included. A total of 396 patients were included in the study. For each patient, we analyzed the sequence and timing for the following management steps: first contact with medical staff, administration of the first antibiotic dose, lumbar puncture (LP), head imaging, and blood cultures. The results were analyzed in relation to clinical characteristics and the referral diagnosis on admission. RESULTS: Of the 396 patient analyzed, 15 (3.7%) had a discharge diagnosis of bacterial meningitis, 119 (30%) had nonbacterial meningitis, and 262 (66.3%) had no evidence of meningitis. Suspicion of meningitis led to earlier antibiotic therapy than suspicion of an acute cerebral event or nonacute cerebral event (P < .0001). In patients with bacterial meningitis, the average time to antibiotics was 136 minutes, with a range of 0 to 340 minutes. Most patients (60.1%) had brain imaging studies performed before LP. On the other hand, half of the patients with a referral diagnosis of meningitis (50%) received antibiotics before performance of an LP. CONCLUSIONS: Few patients with suspected meningitis received antimicrobial therapy within the first 30 minutes after arrival, but most patients with pneumococcal meningitis and typical symptoms were treated early; patients with bacterial meningitis who received treatment late had complex medical histories or atypical presentations.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Lindner, Gregor; Mühlemann, Kathrin and Täuber, Martin G.

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0735-6757

Publisher:

W.B. Saunders

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:40

Last Modified:

08 Sep 2014 09:56

Publisher DOI:

10.1016/j.ajem.2013.03.042

PubMed ID:

23702055

Web of Science ID:

000321550400010

URI:

https://boris.unibe.ch/id/eprint/16228 (FactScience: 223823)

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