[Suspicion of meningitis: evaluation of the management in the emergency unit].

Introduction: Bacterial meningitis is a diagnosis and therapeutic emergency. It is associated with high morbidity and mortality. The objective was to evaluate the management of suspicion of meningitis in an emergency unit, following the update of recommendations.

Methods: A retrospective observational study was conducted between 1st January and 30th June 2009 in the emergency unit of Grenoble University Hospital. Inclusion criteria were: patient aged 15 years and 3 months or older with suspicion of meningitis (fever in the last 24 hours with the presence of at least one meningeal or neurological clinical sign), for whom a lombar puncture was realized in the 48 hours following the admission. Two infectious disease specialists independently evaluated the management of these patients in the emergency unit.

Results: Sixty-eight patients were included. Median time of the lombar puncture was 5.5 hours after admission [25-75 percentiles, 3.7-8,9]. Median time for antibiotic administration was 6 hours after admission [25-75 percentiles, 3.3-8.75]. Lactate prescription was stable during the study period (P=0.58) whereas procalcitonin prescription increased significantly (P=0.02). The realization of a brain scanner before the lumbar puncture was associated with a significant delay in the realization of the lumbar puncture (P<0.001), and was not associated with a delay in the prescription and administration of antimicrobial treatment. According to the infectious disease specialists, an antimicrobial treatment was recommended for 37 patients (54.4%); and 35 of them (94.6%) received an antibiotic in the emergency department. Dosage of ceftriaxone complied with recommendations in 17.8% of cases. A brain scanner was recommended for 33 patients and realized for 25 among them (75.8%). Ten patients (28.6%) had a brain scanner whereas it was not recommended.

Conclusion: Time management was in accordance with those found in previous studies, although higher than those recommended. Consequently it should be reduced. All professionals should be concerned. Staff training and writing of protocols are necessary (especially for the treatment and the brain scanner indications).