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Doctors must give parents explicit advice on spotting sepsis

Half of children with meningococcal infection sent home, not admitted, after first visit to GP

Louise Prime

Friday, 14 September 2018

Doctors need to give parents consistent and explicit “safety netting” advice about recognising meningitis and sepsis, the Meningitis Research Foundation (MRF) has warned. Its latest report* this morning revealed that about half of children with meningococcal infection are sent home after their first GP visit rather than being admitted, and nearly a third of babies with bacterial meningitis receive inappropriate early treatment. The Royal College of GPs (RCGP) said GPs are already permanently alert to signs of meningitis in patients, but said it welcomed any new resources for GPs to share with patients and parents.

The MRF found that three in 10 (30%) young babies with bacterial meningitis received inappropriate early treatment that delayed parents seeking further help, and almost half (49%) of children who have meningococcal infection were sent home after their first visit to a GP and not admitted to hospital. It is calling for an audit of the guidelines, to improve rapid diagnosis and treatment of meningitis.

The charity pointed out that the early signs of meningitis and sepsis are often similar to the symptoms of less serious illnesses; most children with meningococcal meningitis or sepsis display only non-specific symptoms in the first 4-6 hours of illness but can be dead within 24 hours. RCGP chair professor Helen Stokes-Lampard said: “The challenge for all clinicians is that initial symptoms often present in exactly the same way as common viral illnesses such as flu, making both conditions very hard to spot in the early stages of disease.”

The MRF noted in its report that national clinical guidelines recommend that doctors listen to parents’ concerns because they know their child best, and should also give parents “safety netting” information if they send home a child with suspected infection – but this does not always happen. The charity has developed a resources hub on its website with currently available “safety netting” information for parents, to which doctors can direct their patients, or from which they can print out resources to give to parents.

The charity’s chief executive Vinny Smith said: “There’s a real risk that doctors can easily miss meningitis and sepsis in the early stages. Offering patients or parents of children safety netting information could be life-saving if a child with a serious illness is sent home. Parents often have a gut instinct and know when their child is seriously ill. When a child is ill and getting rapidly worse, parents should not be afraid to seek urgent medical help – even if they’ve already been seen by a doctor that same day.”

The RCGP said it welcomed new resources that GPs could share and discuss with patients and parents of young children, to raise awareness of the symptoms of meningitis. Professor Helen Stokes-Lampard said: “GPs are on permanent alert for signs of meningitis in their patients and we do speak to the parents of babies and young children about what they need to look out for which may indicate that an illness could be developing into something much more serious.”

She added: “GPs also recognise that parents and carers are the ones who really know their child best and that listening to a parents’ concerns about their child is often an important indicator of whether something is not right. This is something we will always try to take into account, along with any other physical, psychological and social factors potentially impacting on the health of the patient in front of us.”

*Spotting a seriously ill child: The need for safety netting advice for parents when a sick child is sent home by a health professional. A report prepared by the Meningitis Research Foundation, 2018.

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