Doctors get new guidelines on how to spot meningitis and cut deaths

Published on 28/05/2008 22:01

DEATHS from meningitis and septicaemia could be reduced if the health service followed new guidance on the best standards of care, experts said yesterday.

About 160 cases of invasive meningococcal disease (IMD) are diagnosed in Scotland each year – down from 300 to 350 before the introduction of the meningitis C vaccine in the UK.

But doctors believe that the death rate – which stood last year at 6.4 per cent – could be cut further by making sure children and young people are diagnosed as quickly as possible and get fast and appropriate treatment.

They hope new pointers, from the Scottish Intercollegiate Guidelines Network – an NHS body tasked with improving care across the country – will create a uniform approach to diagnosing and treating IMD.

Doctors across Scotland will be expected to follow the guidance, which sets out a clear pathway, guiding doctors from first seeing children with possible symptoms of IMD to diagnosis and potentially to intensive care.

It also includes "safety netting" to ensure youngsters without a clear diagnosis are not sent away without further checks to see if symptoms get worse.

Dr David Simpson, from the Royal Hospital for Sick Children in Edinburgh, said that while some deaths from IMD were unavoidable, he did not believe the mortality rate was yet at its lowest possible level.

"In the most severe forms, it progresses at an astonishing rate. I think the mortality rate has improved, but I do not think it is at its minimum. I think we could reduce it further," he said.

Dr Simpson, who chaired the guideline development group, said a code was needed to make care uniform and iron out variations in practice across Scotland.

This would improve outcomes for patients and reduce the disabilities caused by meningitis and septicaemia: these can include hearing loss, kidney problems and sometimes amputations. "Early diagnosis and intervention is the key to ensuring successful treatment and a full recovery," Dr Simpson said.

"Although this guidance will not eradicate mortality, adherence will increase the likelihood of a positive outcome and we can hopefully begin to see a significant fall in the number of deaths and disabilities associated with this disease."

Dr Simpson said there was a need to emphasise the evidence about what was best practice.

This showed it was important for children with suspected IMD to be given antibiotics before being urgently referred to hospital for further treatment.

But in some cases, it may not be possible to make a diagnosis from the early symptoms – which include fever, headache and vomiting – because they are also symptoms of other problems, such as viral infections.

In these cases, the guidelines say it is vital that parents are made aware of the need to get emergency help if the symptoms get worse.

In cases where doctors believe it is unlikely, but still possible, that IMD will develop, the guidance says reassessments should be carried out at regular intervals. This "safety netting" is believed to be vital to stop diagnoses being missed and treatment delayed.

Anne Currie, from the Meningitis Trust, said: "These guidelines will not only help doctors but will also benefit parents, carers and anyone else involved in the diagnosis and management of the disease."

Survivor aims to spread the word

WHEN Eilidh Bannerman was just seven years old, her parents believed she would not survive after falling seriously ill with septicaemia.

The youngster was on holiday in Crieff with her family when she started feeling unwell, eventually developing a rash followed by organ failure.

At one point her heart stopped as doctors tried to reduce the effects of the disease on her body.

But now, aged 16, Eilidh is keen to help others struck with meningitis and septicaemia and raise awareness of the disease.

Her family from Hawick, including mother Arlene and father Rory, have since raised thousands of pounds for meningitis charities and the Sick Kids Hospital in Edinburgh.

"I just feel so lucky to be alive," Eilidh said yesterday.

"Other people with meningitis and septicaemia have not been so lucky."

Mrs Bannerman said Eilidh started feeling unwell at teatime and they called an out-of-hours GP. They were told to keep an eye on her and in the night took her to see the doctor, who thought it was a viral infection.

But when her symptoms got worse, the family returned to the GP again and she was immediately sent to hospital in Perth, where her heart stopped and she had to be resuscitated.

She was then taken by ambulance to the Sick Kids in Edinburgh, where she remained for almost a month.

Mrs Bannerman said for the first few days they did not know if Eilidh would survive.

"It was very frightening. We just could not believe it was happening to us.

"It is so important that parents know the symptoms of this disease. You know when your child is ill and it is vital that you get help as soon as possible."

Early symptoms of invasive meningococcal disease, which includes meningitis and septicaemia, include a rash, fever, headache, neck stiffness, mottled skin and cold hands and feet.