Management of Adults With Bacterial Meningitis in the Emergency Department

TL;DR

This paper evaluates how well an emergency department in the UK follows guidelines for treating bacterial meningitis, finding gaps in antibiotic and steroid administration.

Contribution

The study introduces a checklist to improve guideline adherence in bacterial meningitis management within the emergency department.

Findings

Only 25% of prescribers knew the guidelines, and 16.7% used them.

Steroids were administered to only 23% of eligible patients.

Just 3.3% of patients received antibiotics within the first hour as recommended.

Abstract

Introduction: The Leicester Royal Infirmary Emergency Department is one of the largest single-site Emergency Departments in the UK. We evaluated the department’s management of bacterial meningitis. The current national guideline recommends that all patients presenting with suspected bacterial meningitis receive antibiotics within one hour.

Methods: A survey of 100 clinicians (Consultants, Registrars, House Officers, and Advanced Clinical Practitioners) working in the Emergency Department was performed to determine the awareness of the guidelines and a retrospective examination of case notes for patients who presented at the Leicester Royal Infirmary Emergency Department with suspected meningitis was carried out between May 1, 2022, and May 1, 2023. A random sample of 30 patients was drawn from the department's database of 190 patients, identified through discharge coding summaries.

Results: Nine (25%) of the prescribers knew of the guidelines for managing meningitis, and six (16.7%) had utilised the hospital guidelines. Thirty-three (91.7%) prescribers acknowledged the importance of administering steroids to patients suspected of having bacterial meningitis (excluding those displaying signs of meningococcal sepsis, such as a rash). However, only seven (23%) of patients received this treatment. Additionally, only one (3.3%) patient was documented as having received a dose within the first hour of presentation.

Conclusion: The timely diagnosis and administration of appropriate antibiotic therapy are pivotal elements in managing bacterial meningitis. As a result, we designed a checklist to facilitate the effective management of meningitis within the department by increasing awareness of the guidelines and making the critical principles of suspected meningitis management more accessible.

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