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Multicenter Study
. 2012 Sep 7:12:145.
doi: 10.1186/1471-2431-12-145.

Suboptimal management of central nervous system infections in children: a multi-centre retrospective study

Christine Kelly  1 , Aman Sohal, Benedict D Michael, Andrew Riordan, Tom Solomon, Rachel Kneen; Northwest Neurological Infections Network
Collaborators, Affiliations
Multicenter Study

Suboptimal management of central nervous system infections in children: a multi-centre retrospective study

Christine Kelly et al. BMC Pediatr. .

Abstract

Objective: We aimed to audit the regional management of central nervous system (CNS) infection in children.

Methods: The study was undertaken in five district general hospitals and one tertiary paediatric hospital in the Mersey region of the UK. Children admitted to hospital with a suspected CNS infection over a three month period were identified. Children were aged between 4 weeks and 16 years old. Details were recorded from the case notes and electronic records. We measured the appropriateness of management pathways as outlined by national and local guidelines.

Results: Sixty-five children were identified with a median age of 6 months (range 1 month to 15 years). Ten had a CNS infection: 4 aseptic meningitis, 3 purulent meningitis, 3 encephalitis [2 with herpes simplex virus (HSV) type 1]. A lumbar puncture (LP) was attempted in 50 (77%) cases but only 43 had cerebrospinal fluid (CSF) available for analysis. Of these 24 (57%) had a complete standard set of tests performed. Fifty eight (89%) received a third generation cephalosporin. Seventeen (26%) also received aciclovir with no obvious indication in 9 (53%). Only 11 (65%) of those receiving aciclovir had CSF herpes virus PCR. Seventeen had cranial imaging and it was the first management step in 14. Treatment lengths of both antibiotics and aciclovir were highly variable: one child with HSV encephalitis was only treated with aciclovir for 7 days.

Conclusions: The clinical management of children with suspected CNS infections across the Mersey region is heterogeneous and often sub-optimal, particularly for the investigation and treatment of viral encephalitis. National guidelines for the management of viral encephalitis are needed.

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Figures

Figure 1
Figure 1
Suspected and final diagnosis for 65 children investigated or treated for suspected CNS infection.
Figure 2
Figure 2
Order of management steps and final diagnosis for 65 children with suspected CNS infection.
See this image and copyright information in PMC

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