Letter: It's better to be safe than sorry with meningitis

Dear Editor

I was concerned by the responses to the practice dilemma.

The situation given was this: you are called urgently to assist one of your partners with a child with a purpuric rash, whom she has already assessed and diagnosed as having possible meningitis.

Urgent calls to the ambulance and the paediatric team are under way.

Should you call a halt to all this simply because, on the basis of your initial glance, you are 'doubtful of the diagnosis'?

Apparently so, according to two of the responses.

The representative from the Patient Partnership Group is 'concerned about the conduct' of a doctor who, faced with a possible diagnosis of a life-threatening disease in which minutes count, chose to arrange hospital admission immediately rather than take the time to discuss it with a colleague.

Surely, if a doctor feels that the risk of meningitis was too high for her to feel comfortable with any other action than urgent admission, it is completely appropriate for her to arrange this without wasting time on a second opinion? I was quite staggered by his apparent belief that treating a medical emergency as urgent somehow indicates a lack of compassion for parents' feelings.

I would have held this up as an example of how misguided patient representatives can be about the realities of medical practice, but, sadly, I have to say that the advice from the GP responding wasn't much better.

I am uncertain how she thinks any doctor could be 'convinced' that a child does not have a disease that is so notoriously difficult to diagnose in its early stages.

Of course, we all have to make judgment calls. However, faced with a situation where a competent colleague believed there was a high risk of a child she had already assessed having meningitis (particularly if the child had a red flag symptom such as a non-blanching rash), I consider it inappropriate to call for any delay in getting the child to hospital.

Any harm done by a 999 call that proves, with the benefit of hindsight, to have been unnecessary, is more than outweighed by the potential risks of not acting with the greatest possible speed once a doctor has strong reason to suspect meningitis.

This scenario reminded me of my own experience as a paediatric SHO, where I saw a child who had the beginnings of a petechial rash but did not appear acutely unwell.

I adopted a 'watch and wait' policy, ordered antibiotics an hour later since the rash seemed to be starting to spread, and went home a few hours later at the conclusion of my night shift. On returning that same evening for my next shift, I found that the child had died from meningococcal septicaemia that afternoon.

The consultant assured me that my response had been reasonable under the circumstances; and, by the Bolam test, I'm sure it was. It would also have been reasonable to have started antibiotics on first seeing the rash.

I will never know whether that hour could have made a difference.

Dr Sarah Vaughan, Downend, Bristol

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