F A Riordan1. 1. Department of Child Health, Birmingham Heartlands and Solihull NHS Trust, Bordesley Green East, UK. evansk@heartsol.wmids.nhs.uk
Abstract
OBJECTIVES: Delays in parenteral antibiotic treatment may contribute to the high mortality in meningococcal disease. This study aimed to record "door to needle" time in children with meningococcal disease before and after the introduction of a specific teaching programme about the disease. METHODS: "Door to needle" time in 33 children with meningococcal disease, admitted June 1995-December 1996, were studied. Regular teaching sessions encouraging prompt treatment were started in January 1997. "Door to needle" time was then studied for 42 children admitted January 1997-December 1998. RESULTS: More of the second cohort attended accident and emergency (A&E) directly (9 of 33 v 24 of 42; p=0.01) rather than being referred by a GP. Similar proportions received pre-admission antibiotics from a GP (8 of 24 v 5 of 18). Mortality was similar in the two groups (2 of 33 v 5 of 42). "Door to needle" time was significantly shorter in the second cohort in those with a typical rash (median 60 minutes v 18 minutes; p=0.0004). Only 1 of 23 (4%) children in the second cohort with a typical, petechial rash waited more than 60 minutes for antibiotics, compared with 6 of 24 in the first cohort (p=0.06). CONCLUSIONS: Significant improvements in "door to needle" time in meningococcal disease can be achieved when awareness is heightened by regular teaching. Those with a typical, petechial rash can be treated within 60 minutes of arrival. Strategies to improve immediate treatment of meningococcal disease should include education of A&E staff, especially as an increasing proportion of cases present directly to A&E.
OBJECTIVES: Delays in parenteral antibiotic treatment may contribute to the high mortality in meningococcal disease. This study aimed to record "door to needle" time in children with meningococcal disease before and after the introduction of a specific teaching programme about the disease. METHODS: "Door to needle" time in 33 children with meningococcal disease, admitted June 1995-December 1996, were studied. Regular teaching sessions encouraging prompt treatment were started in January 1997. "Door to needle" time was then studied for 42 children admitted January 1997-December 1998. RESULTS: More of the second cohort attended accident and emergency (A&E) directly (9 of 33 v 24 of 42; p=0.01) rather than being referred by a GP. Similar proportions received pre-admission antibiotics from a GP (8 of 24 v 5 of 18). Mortality was similar in the two groups (2 of 33 v 5 of 42). "Door to needle" time was significantly shorter in the second cohort in those with a typical rash (median 60 minutes v 18 minutes; p=0.0004). Only 1 of 23 (4%) children in the second cohort with a typical, petechial rash waited more than 60 minutes for antibiotics, compared with 6 of 24 in the first cohort (p=0.06). CONCLUSIONS: Significant improvements in "door to needle" time in meningococcal disease can be achieved when awareness is heightened by regular teaching. Those with a typical, petechial rash can be treated within 60 minutes of arrival. Strategies to improve immediate treatment of meningococcal disease should include education of A&E staff, especially as an increasing proportion of cases present directly to A&E.