Diagnostic problems with meningococcal disease in general practice
Based on general practitioners' referral letters and hospital records, we made a retrospective analysis of a cohort of 177 consecutive cases of meningococcal disease that occurred during a period of 10 years in the County of North Jutland, Denmark. The analysis concerned diagnostic problems in...
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| Veröffentlicht in: | Journal of clinical epidemiology 1992-11, Vol.45 (11), p.1289-1293 |
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| container_title | Journal of clinical epidemiology |
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| creator | Toft Sørensen, Henrik Møller-Petersen, Jens Bygum Krarup, Henrik Pedersen, Helena Hansen, Helle Hamburger, Henrik |
| description | Based on general practitioners' referral letters and hospital records, we made a retrospective analysis of a cohort of 177 consecutive cases of meningococcal disease that occurred during a period of 10 years in the County of North Jutland, Denmark. The analysis concerned diagnostic problems in general practice, prognosis, pre-hospital antibiotic treatment and its effect on subsequent cultures, and degree of obligatory notification. The referring doctor suspected meningococcal disease/central nervous infection in 123 patients (69.5%). Neck stiffness and petechiae were related to a correct referral diagnosis, in contrast to the occurrence of a non-petechial rash. The presence of disseminated intravascular coagulation was associated with the mortality rate, which was 0.062. The therapeutic recommendations of the Danish Health Authorities were followed in only 25 of the 98 patients who fulfilled the criteria for pre-hospital parenteral antibiotic treatment. Pre-hospital antibiotic treatment was related to negative culture of spinal fluid or blood. Seven of the 177 patients were not notified according to the rules. Difficulties in pre-hospital diagnosis seem not to influence the lethal course of the disease. |
| doi_str_mv | 10.1016/0895-4356(92)90169-N |
| format | Article |
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The analysis concerned diagnostic problems in general practice, prognosis, pre-hospital antibiotic treatment and its effect on subsequent cultures, and degree of obligatory notification. The referring doctor suspected meningococcal disease/central nervous infection in 123 patients (69.5%). Neck stiffness and petechiae were related to a correct referral diagnosis, in contrast to the occurrence of a non-petechial rash. The presence of disseminated intravascular coagulation was associated with the mortality rate, which was 0.062. The therapeutic recommendations of the Danish Health Authorities were followed in only 25 of the 98 patients who fulfilled the criteria for pre-hospital parenteral antibiotic treatment. Pre-hospital antibiotic treatment was related to negative culture of spinal fluid or blood. Seven of the 177 patients were not notified according to the rules. Difficulties in pre-hospital diagnosis seem not to influence the lethal course of the disease.</description><identifier>ISSN: 0895-4356</identifier><identifier>EISSN: 1878-5921</identifier><identifier>DOI: 10.1016/0895-4356(92)90169-N</identifier><identifier>PMID: 1432009</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Anti-Bacterial Agents - administration & dosage ; Anti-Bacterial Agents - therapeutic use ; Bacterial diseases ; Bacterial diseases of the nervous system. Bacterial myositis ; Biological and medical sciences ; Child ; Child, Preschool ; Clinical Protocols - standards ; Denmark - epidemiology ; Diagnosis ; Disseminated Intravascular Coagulation - epidemiology ; Disseminated Intravascular Coagulation - etiology ; Disseminated Intravascular Coagulation - mortality ; Emergency Medical Services - standards ; Emergency Medical Services - statistics & numerical data ; Family practice ; Family Practice - standards ; Family Practice - statistics & numerical data ; Female ; Human bacterial diseases ; Humans ; Infant ; Infectious diseases ; Logistic Models ; Male ; Medical sciences ; Meningitis ; Meningitis, Meningococcal - complications ; Meningitis, Meningococcal - diagnosis ; Meningitis, Meningococcal - drug therapy ; Meningococcal disease ; Middle Aged ; Neisseria meningitidis ; Practice Patterns, Physicians' - standards ; Practice Patterns, Physicians' - statistics & numerical data ; Predictive Value of Tests ; Prognosis ; Referral ; Referral and Consultation - statistics & numerical data ; Serotyping ; Survival Rate</subject><ispartof>Journal of clinical epidemiology, 1992-11, Vol.45 (11), p.1289-1293</ispartof><rights>1992</rights><rights>1993 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-8894fc7132d8a11d540f1807badbed614a24ae9a10415893c769367a499a4d8f3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/0895-4356(92)90169-N$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=4395238$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/1432009$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Toft Sørensen, Henrik</creatorcontrib><creatorcontrib>Møller-Petersen, Jens</creatorcontrib><creatorcontrib>Bygum Krarup, Henrik</creatorcontrib><creatorcontrib>Pedersen, Helena</creatorcontrib><creatorcontrib>Hansen, Helle</creatorcontrib><creatorcontrib>Hamburger, Henrik</creatorcontrib><title>Diagnostic problems with meningococcal disease in general practice</title><title>Journal of clinical epidemiology</title><addtitle>J Clin Epidemiol</addtitle><description>Based on general practitioners' referral letters and hospital records, we made a retrospective analysis of a cohort of 177 consecutive cases of meningococcal disease that occurred during a period of 10 years in the County of North Jutland, Denmark. The analysis concerned diagnostic problems in general practice, prognosis, pre-hospital antibiotic treatment and its effect on subsequent cultures, and degree of obligatory notification. The referring doctor suspected meningococcal disease/central nervous infection in 123 patients (69.5%). Neck stiffness and petechiae were related to a correct referral diagnosis, in contrast to the occurrence of a non-petechial rash. The presence of disseminated intravascular coagulation was associated with the mortality rate, which was 0.062. The therapeutic recommendations of the Danish Health Authorities were followed in only 25 of the 98 patients who fulfilled the criteria for pre-hospital parenteral antibiotic treatment. Pre-hospital antibiotic treatment was related to negative culture of spinal fluid or blood. Seven of the 177 patients were not notified according to the rules. Difficulties in pre-hospital diagnosis seem not to influence the lethal course of the disease.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Bacterial diseases</subject><subject>Bacterial diseases of the nervous system. Bacterial myositis</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical Protocols - standards</subject><subject>Denmark - epidemiology</subject><subject>Diagnosis</subject><subject>Disseminated Intravascular Coagulation - epidemiology</subject><subject>Disseminated Intravascular Coagulation - etiology</subject><subject>Disseminated Intravascular Coagulation - mortality</subject><subject>Emergency Medical Services - standards</subject><subject>Emergency Medical Services - statistics & numerical data</subject><subject>Family practice</subject><subject>Family Practice - standards</subject><subject>Family Practice - statistics & numerical data</subject><subject>Female</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infant</subject><subject>Infectious diseases</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Meningitis</subject><subject>Meningitis, Meningococcal - complications</subject><subject>Meningitis, Meningococcal - diagnosis</subject><subject>Meningitis, Meningococcal - drug therapy</subject><subject>Meningococcal disease</subject><subject>Middle Aged</subject><subject>Neisseria meningitidis</subject><subject>Practice Patterns, Physicians' - standards</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Referral</subject><subject>Referral and Consultation - statistics & numerical data</subject><subject>Serotyping</subject><subject>Survival Rate</subject><issn>0895-4356</issn><issn>1878-5921</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1992</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkMtKBDEQRYMoOj7-QKEXIrpoTXXSnWQj-FYQ3eg6ZJLqMdKPMelR_HszzqA7XRVUnVtcDiG7QI-BQnVCpSpzzsrqUBVHKm1U_rBCRiCFzEtVwCoZ_SAbZDPGV0pBUFGuk3XgrKBUjcj5pTeTro-Dt9k09OMG25h9-OEla7Hz3aS3vbWmyZyPaCJmvssm2GFIq2kwNsVwm6zVpom4s5xb5Pn66uniNr9_vLm7OLvPLQcx5FIqXlsBrHDSALiS0xokFWPjxugq4KbgBpUByqGUillRKVYJw5Uy3MmabZGDxd_U822GcdCtjxabxnTYz6IWjBWMM_kvCBWvQFZlAvkCtKGPMWCtp8G3JnxqoHruWM8F6rlArQr97Vg_pNje8v9s3KL7DS2kpvv-8m5iclcH01kffzDOVFl81zxdYJikvXsMOlqPnUXnA9pBu97_3eMLPQyXCQ</recordid><startdate>19921101</startdate><enddate>19921101</enddate><creator>Toft Sørensen, Henrik</creator><creator>Møller-Petersen, Jens</creator><creator>Bygum Krarup, Henrik</creator><creator>Pedersen, Helena</creator><creator>Hansen, Helle</creator><creator>Hamburger, Henrik</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>19921101</creationdate><title>Diagnostic problems with meningococcal disease in general practice</title><author>Toft Sørensen, Henrik ; Møller-Petersen, Jens ; Bygum Krarup, Henrik ; Pedersen, Helena ; Hansen, Helle ; Hamburger, Henrik</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-8894fc7132d8a11d540f1807badbed614a24ae9a10415893c769367a499a4d8f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1992</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Bacterial diseases</topic><topic>Bacterial diseases of the nervous system. Bacterial myositis</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Clinical Protocols - standards</topic><topic>Denmark - epidemiology</topic><topic>Diagnosis</topic><topic>Disseminated Intravascular Coagulation - epidemiology</topic><topic>Disseminated Intravascular Coagulation - etiology</topic><topic>Disseminated Intravascular Coagulation - mortality</topic><topic>Emergency Medical Services - standards</topic><topic>Emergency Medical Services - statistics & numerical data</topic><topic>Family practice</topic><topic>Family Practice - standards</topic><topic>Family Practice - statistics & numerical data</topic><topic>Female</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Infant</topic><topic>Infectious diseases</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Meningitis</topic><topic>Meningitis, Meningococcal - complications</topic><topic>Meningitis, Meningococcal - diagnosis</topic><topic>Meningitis, Meningococcal - drug therapy</topic><topic>Meningococcal disease</topic><topic>Middle Aged</topic><topic>Neisseria meningitidis</topic><topic>Practice Patterns, Physicians' - standards</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Referral</topic><topic>Referral and Consultation - statistics & numerical data</topic><topic>Serotyping</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Toft Sørensen, Henrik</creatorcontrib><creatorcontrib>Møller-Petersen, Jens</creatorcontrib><creatorcontrib>Bygum Krarup, Henrik</creatorcontrib><creatorcontrib>Pedersen, Helena</creatorcontrib><creatorcontrib>Hansen, Helle</creatorcontrib><creatorcontrib>Hamburger, Henrik</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Toft Sørensen, Henrik</au><au>Møller-Petersen, Jens</au><au>Bygum Krarup, Henrik</au><au>Pedersen, Helena</au><au>Hansen, Helle</au><au>Hamburger, Henrik</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic problems with meningococcal disease in general practice</atitle><jtitle>Journal of clinical epidemiology</jtitle><addtitle>J Clin Epidemiol</addtitle><date>1992-11-01</date><risdate>1992</risdate><volume>45</volume><issue>11</issue><spage>1289</spage><epage>1293</epage><pages>1289-1293</pages><issn>0895-4356</issn><eissn>1878-5921</eissn><abstract>Based on general practitioners' referral letters and hospital records, we made a retrospective analysis of a cohort of 177 consecutive cases of meningococcal disease that occurred during a period of 10 years in the County of North Jutland, Denmark. 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| subjects | Adolescent Adult Aged Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - therapeutic use Bacterial diseases Bacterial diseases of the nervous system. Bacterial myositis Biological and medical sciences Child Child, Preschool Clinical Protocols - standards Denmark - epidemiology Diagnosis Disseminated Intravascular Coagulation - epidemiology Disseminated Intravascular Coagulation - etiology Disseminated Intravascular Coagulation - mortality Emergency Medical Services - standards Emergency Medical Services - statistics & numerical data Family practice Family Practice - standards Family Practice - statistics & numerical data Female Human bacterial diseases Humans Infant Infectious diseases Logistic Models Male Medical sciences Meningitis Meningitis, Meningococcal - complications Meningitis, Meningococcal - diagnosis Meningitis, Meningococcal - drug therapy Meningococcal disease Middle Aged Neisseria meningitidis Practice Patterns, Physicians' - standards Practice Patterns, Physicians' - statistics & numerical data Predictive Value of Tests Prognosis Referral Referral and Consultation - statistics & numerical data Serotyping Survival Rate |
| title | Diagnostic problems with meningococcal disease in general practice |
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