Health care delivery and the outcome of meningococcal disease in children
Research archive
- Imperial College School of Medicine at St Mary's Hospital, London, UK, Royal College of Paediatrics and Child Health, London, UK
- Researchers:
Dr Linda Haines, Dr Roderick McFaul, Professor Michael Levin, Professor Richard Cooke
- Project Number: 9607.0
- Category: Treatment
- Duration: 1997-2002
- Start Date: 01 January 1997
- Type: Scientific
Meningococcal infection remains an important cause of childhood morbidity and mortality. Most deaths in meningococcal infection are due to meningococcal septicaemia rather than meningitis. Despite the availability of potent antibiotics to which the meningococcus bacterium is highly sensitive, the overall mortality rate remains at 10%, increasing to 40% in patients who present in shock. There are two likely major factors responsible for the continued high mortality from meningococcal shock:
1. Ineffective treatment of the pathophysiology of meningococcal shock.
2. Health care delivery: children with meningococcal septicaemia may develop profound shock and die within 24-48 hours of the first symptom. Delay or inappropriate treatment at any stage in the interaction of the child and health care system may adversely affect the prognosis.
The present study aims to:
- document all deaths in children under 17 years caused by meningococcal disease over a 2-year period in England and Wales.
- conduct a case control study based on these subjects to compare the standard of health care delivery in fatal and non-fatal cases. Factors to be compared will include: time between onset of illness and institution of appropriate management by GP's, casualty officers, and the paediatric team; whether the patients were managed on a general paediatric ward or intensive care unit; delays incurred (if any) in gaining access to an intensive care unit; and the adequacy and extent of measures used to treat circulatory collapse, impaired perfusion, raised intracranial pressure and organ failure.
Read our news releases about this project:
Meningitis 'Red Flag' Symptoms
Pre-hospital antibiotics and preventing deaths from meningitis and septicaemia
Research identifies early warning signs of meningitis and septicaemia
Avoidable child deaths from meningitis and septicaemia
Results from this study have been published in scientific journals as follows:
Ninis N, Phillips C, Bailey L, Pollock JL, Nadel S, Britto J, Maconochie I, Winrow A, Coen PG, Booy R, Levin M.
The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases.
BMJ 2005 Jun 25;330(7506):1475.
http://bmj.bmjjournals.com/cgi/reprint/330/7506/1475.pdf
Thompson M, Ninis N, Perera R, Mayon-White R, Phillips C, Bailey L, Harnden A, Mant D, Levin M,
Clinical recognition of meningococcal disease in children and adolescents.
Lancet 2006 Feb 4;367(9508):397-403.
http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(06)67932-4
Harnden A, Ninis N, Thompson M, Perera R, Levin M, Mant D, Mayon-White R.
Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study.
BMJ 2006 Jun 3;332(7553):1295-8. Epub 2006 Mar 22..
http://www.bmj.com/cgi/reprint/332/7553/1295