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Written on 15th July 2022 by Susan Brown

A new study into the care given to adult patients with meningitis in UK and Irish hospitals has found that care often fails to comply with clinical guidelines.

The study looked back and analysed the care given to 1471 adults with suspected bacterial meningitis in 2017 across 64 hospitals in the UK and Ireland. The study assessed the management of these patients at each stage of their hospital treatment. It is believed to be the largest UK national study into the management of meningitis ever published.

What did the study find?

The researchers compared the care that was given to these patients with 30 clinical standards from the 2016 UK joint specialists societies guideline on diagnosis and management of meningitis.

Their findings included:

  • none of the 1471 patients received care which fully complied with the clinical standards 100% of the time;
  • 20 out of the 30 standards were followed in only 50% (or fewer) cases;

In the majority of cases, they found delays in the use of standard diagnostic tests, such as lumbar punctures and blood tests, and the administration of medication, such as antibiotics and steroids.

  • Only 19% of patients who were treated with antibiotics received them within one hour of arrival at hospital.
  • 36% of patients who had a confirmed diagnosis of bacterial meningitis received antibiotics within an hour of arrival;
  • the average (median) time from a patient’s hospital admission to their first dose of antibiotics was over three hours.

The study points out that previous research has shown that a delay of over three hours in giving antibiotics for  bacterial meningitis has been linked with a 14-fold increase in risk of death.  

  • Lumbar puncture (or ‘spinal tap’)  to take and test cerebrospinal fluid (CSF) should be performed within one hour of arrival but this only happened for 0.6% of patients.

The study points out that delays in obtaining CFS reduce the likelihood of finding the cause of the patient’s meningitis, making it more difficult to treat the patient effectively with antibiotics which target the specific cause of their infection. This also increases the risk of the patient receiving unnecessary or inappropriate antibiotics and can lead to prolonged hospital stays and poorer outcomes.

  • A significant number of patients had unnecessary brain scans before their lumbar puncture was carried out, causing further delay.
  • Only 16% of all cases were documented to have been reported to the relevant public health authority. Public health authority notification of certain diseases is a critical step in monitoring and controlling outbreaks of dangerous infections.

The researchers concluded that their findings show that hospital care for patients with meningitis in the UK is not in line with current, evidence-based, national guidelines. The finding that current medical practice falls short of the recommendations in the 2016 UK guidelines is a concern for all patients, but particularly worrying for patients with  bacterial meningitis, whose survival and outcome depends on time-critical treatment.

The researchers call for further work to be done to  improve the diagnosis and treatment of bacterial meningitis, including a national strategic improvement plan to focus on timely use of diagnostics, appropriate antibiotics in at risk populations and the use of adjunctive steroids. They also recommend further work to learn more about why guidelines are not followed and to ensure they are followed in practice. As these patients’ hospital care often begins with admission via an emergency department, where clinical staff are less familiar with the guidelines, the researchers point out that existing UK clinical guidelines recommend that meningitis patients should be treated with input from infection specialists.

Claire Wright, Head of Evidence and Policy at the Meningitis Research Foundation, commented:

Every hour matters in treating meningitis, with heart-breaking implications when the appropriate clinical care is not given. With new National Institute for Clinical Excellence (NICE) guidelines on the diagnosis and treatment of meningitis in development, these findings must inform them. It’s not enough to have evidence-based guidelines, we must also understand what makes the right environment, including training and support, for those doctors and nurses on the front line, to ensure everyone who gets meningitis has the best possible outcome. This would be an important study in any year but is particularly timely now, with the recent rise in cases amongst young adults, as reported by the UKHSA in January (and a very recent cluster of cases in Yorkshire).

Compensation for injury and disability after negligent meningitis care

Bacterial meningitis is a medical emergency. Survival and recovery from this deadly disease depends on early diagnosis and emergency hospital treatment with antibiotics. Delays in diagnosis and treatment can result in death or devastating injury, leaving a lifetime of disability from the effects of brain injury, amputation and psychological injury.

This study is the largest of its kind and its disturbing findings suggest that meningitis patients across Britain are at risk of avoidable harm from widespread failings in hospital treatment which does not follow accepted guidance or comply with recognised standards of clinical care. Where patients are severely injured, or die leaving dependent family, as a result of negligent ambulance or hospital care of meningitis, they or their family may be entitled to compensation.

Boyes Turner’s clinical negligence team have helped countless individuals recover compensation to help them rehabilitate, restore their mobility and independence, adapt their homes and rebuild their lives after negligent care has caused permanent injury from meningitis.

If you have suffered severe injury or disability as a result of medical negligence and would like to find out more about making a claim, you can talk to one of our experienced solicitors, free and confidentially, about making a claim, by contacting us here.