'Early diagnosis can save lives' says new guideline for meningitis

‘EARLY DIAGNOSIS CAN SAVE LIVES’ SAYS NEW GUIDELINE FOR MENINGITIS
GUIDELINE IS MOST COMPREHENSIVE REVIEW OF EVIDENCE TO DATE

A new guideline published today (Wednesday) says early diagnosis of Invasive Meningococcal Disease (IMD) is the key to saving the lives of children and young people who contract the disease. The new guideline from the Scottish Intercollegiate Guidelines Network (SIGN) - part of NHS Quality Improvement Scotland (NHS QIS) – is seen as the most comprehensive review to date of the evidence on how best to diagnose and treat IMD.

A media briefing will be held today in the boardroom at 10.00am in Edinburgh’s Dynamic Earth. A young girl who survived meningitis will attend to talk about how she survived the disease.

The meningococcal organism can cause both meningitis and septicaemia and is still a significant cause of mortality in children and young people. Although the incidence of IMD has fallen to between 140 and 160 cases in Scotland each year, between 2.6-10% of those who contract the disease each year die. Most deaths occur within the first 24 hours, frequently before the patient receives specialist care. This poses a challenge to those in the healthcare system to identify children and young people who will rapidly progress from early symptoms to a life-threatening state. The particular geography and population distribution in Scotland - combined with the rapid onset and progression of the disease - required the development of a guideline that ensured the most effective treatment delivered within the context of the Scottish Health Service.

Key aspects of the guideline are as follows:

In primary care, the challenge is discriminating the few children with early meningococcal disease from the many with other less harmful viral illnesses. We have devised a flowchart to facilitate early management.
Effective communication between primary, secondary and paediatric intensive care is vital to ensure rapid escalation of treatment in the early phase of invasive meningococcal disease. The guideline development group believes that the importance of these organisational aspects cannot be overestimated.
Corticosteroids are not recommended for the treatment of children with meningococcal septicaemia, with the notable exception of steroid dose titration as rescue treatment in particular circumstances.
Early treatment includes the administration of antibiotics as soon as meningococcal disease is suspected, and early assessment and supervision by senior clinicians.
Severe cases will require significant resuscitation, including intravenous fluids and the capacity to support ventilation and blood pressure.
Corticosteroids are recommended for the treatment of children with meningitis, but not with meningococcal septicaemia.

The guideline focuses on the following areas:

Early assessment and treatment of the condition
Hospital care
Prevention of secondary transmission
Follow-up care.

Dr David Simpson, Consultant in Paediatric Anaesthesia and Intensive Care at the Royal Hospital for Sick Children in Edinburgh and chair of the guideline development group, said: “This is an important guideline that gathers together the best current evidence on early recognition, diagnosis and treatment. Early diagnosis and intervention is the key to ensuring successful treatment and a full recovery. Although this guideline 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.”

Editors Note:

Meningococcal bacteria can cause both meningitis and septicaemia. Together these are known as meningococcal disease. Meningitis is inflammation of the meninges, the linings that surround and protect the brain. Septicaemia (blood poisoning) is caused when bacteria enter the bloodstream and multiply uncontrollably. Although a successful vaccine against the ‘C’ form of meningitis exists, there is currently no licensed vaccine in the UK against the ‘B’ form of the disease.
The number of cases of IMD is monitored by the Health Protection Scotland (HPS) Meningococcal Invasive Disease Augmented Surveillance (MIDAS) scheme. Since 2000 the incidence of IMD has reduced to between 140 -160 new IMD cases each year. A number of factors including increased awareness, public health measures, early resuscitation, improved resuscitation techniques, advances in critical care, surgical interventions and investment in rehabilitation are likely to have contributed to improvements in outcome.
SIGN develops national clinical guidelines aimed at reducing variations in clinical practice and in outcomes for patients. Founded in 1993, SIGN became part of the national clinical effectiveness body, NHS Quality Improvement Scotland, on 1 January 2005.
NHS Quality Improvement Scotland has been established to lead in improving the quality of care and treatment delivered by NHSScotland. To do this it sets standards and monitors performance, and provides NHSScotland with advice, guidance and support on effective clinical practice and service improvements.
The SIGN guideline, ‘Management of invasive meningococcal disease in children and young people - A national clinical guideline’, is available from www.sign.ac.uk.

Media Contact: Stephen Ferguson on 07779 329 689