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July 2018

Patients with suspected meningitis face diagnostic delays



Patients referred to hospital with suspected meningitis face substantial delays in diagnostic testing, research published in The Lancet Infectious Diseases has found.

The median time from admission to a lumbar puncture to distinguish between bacterial and viral meningitis was 17 hours, and in a quarter of patients it took more than 29 hours.

The study is the first of its kind to examine the incidence, causes, and impact of viral meningitis in UK adults.

International guidelines stress the urgency of lumbar puncture in order to rule out bacterial meningitis and reduce unnecessary antibiotic treatment, shorten hospital stays, and lessen healthcare costs.

The study found that the chances of having a pathogen detected in viral meningitis reduced by 1% for every hour delay in lumbar puncture following admission.

Dr Fiona McGill, the Institute of Infection and Global Health at the University of Liverpool, UK, who led the research. ‘It’s possible that the 4-hour A&E treatment target is leading to key investigations like lumbar puncture being postponed until patients have been admitted to a ward.’

Since the 1990s, widespread introduction of conjugate vaccines have seen the incidence of bacterial meningitis decline across England, and cases of viral meningitis appear to have risen. Although symptoms can be similar, individuals with viral meningitis usually get better in a few weeks, while bacterial meningitis can kill within hours and requires urgent treatment with antibiotics. However, the study reveals that recovery from viral meningitis can still be a long haul for patients, with many still experiencing memory and mental health problems months after they are released from hospital.


McGill F, et al. Lancet Infect Dis 2018. ePub 29 June 2018.

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30245-7/fulltext

July 2018