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Journal of Public Health Advance Access published online on July 28, 2009
Journal of Public Health, doi:10.1093/pubmed/fdp075
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© The Author 2009, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Invasive meningococcal disease—improving management through structured review of cases in the Hunter New England area, Australia


Chantal Guimont, Associate Professor of Medicine1
Carolyn Hullick, Director, John Hunter Hospital Emergency Department2
David Durrheim, Service Director Health Protection & Conjoint Professor of Public Health3
Nick Ryan, Service Director, Health Protection & Conjoint Senior Lecturer of Medicine4
John Ferguson, Senior Lecturer of Microbiology and Infectious Disease5
Peter Massey, Adjunct Senior Lecturer of Public Health6

1 Emergency Department, Centre Hospitalier de l'Université Laval, Quebec, Canada
2 Emergency Department, Hunter New England Health, Newcastle, Australia
3 Health Protection, Hunter New England Population Health, Wallsend, Australia
4 Emergency Department, Tamworth Base Hospital, Tamworth, Australia
5 Infection Prevention and Control, Hunter New England Health, Newcastle, Australia
6 Health Protection, Hunter New England Population Health, Tamworth, Australia


Address correspondence to Dr Chantal Guimont, E-mail: chantal.guimont{at}crchul.ulaval.ca


  Abstract

Introduction Invasive meningococcal disease (IMD) is the most common infectious cause of death in childhood in developed countries. This disease may cause severe disability or death if a patient is sub-optimally managed. An audit was performed in Australia of all 2005–06 notified IMD cases to elicit correctable issues.

Methods Over the 2 year period, 24 cases were notified in the Hunter New England Health area. These cases were reviewed by an expert panel to highlight key correctable issues in recognition and management of IMD.

Results The 24 patients were aged between 1 month and 70 years. Thirteen (54%) were children and 14 (58%) were women. Six (25%) cases developed complications, two being severe (one death, one limb amputations). These patients had risk factors for IMD. The emergency department average delay between assessment and administration of antibiotics was 57.8 min.

Conclusion There were avoidable factors identified in both patients with a poor outcome. Length of delay in initiating antibiotic therapy has been associated with poor outcome, thus the delay in our series is of concern. The audit highlighted many potentially correctable issues in the medical, laboratory and public health management of IMD cases.

Keywords: diagnosis, emergency care, public health


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