title: Clinical recognition of meningococcal disease in children and adolescents.
abstract: BACKGROUND
  Meningococcal disease is a rapidly progressive childhood infection of global importance. To our knowledge, no systematic quantitative research exists into the occurrence of symptoms before admission to hospital.
  
  
  METHODS
  Data were obtained from questionnaires answered by parents and from primary-care records for the course of illness before admission to hospital in 448 children (103 fatal, 345 non-fatal), aged 16 years or younger, with meningococcal disease. In 373 cases, diagnosis was confirmed with microbiological techniques. The rest of the children were included because they had a purpuric rash, and either meningitis or evidence of septicaemic shock. Results were standardised to UK case-fatality rates.
  
  
  RESULTS
  The time-window for clinical diagnosis was narrow. Most children had only non-specific symptoms in the first 4-6 h, but were close to death by 24 h. Only 165 (51%) children were sent to hospital after the first consultation. The classic features of haemorrhagic rash, meningism, and impaired consciousness developed late (median onset 13-22 h). By contrast, 72% of children had early symptoms of sepsis (leg pains, cold hands and feet, abnormal skin colour) that first developed at a median time of 8 h, much earlier than the median time to hospital admission of 19 h.
  
  
  CONCLUSIONS
  Classic clinical features of meningococcal disease appear late in the illness. Recognising early symptoms of sepsis could increase the proportion of children identified by primary-care clinicians and shorten the time to hospital admission. The framework within which meningococcal disease is diagnosed should be changed to emphasise identification of these early symptoms by parents and clinicians.
authors.affiliation: Department of Primary Health Care, Old Road Campus, University of Oxford, Oxford, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Thompson
authors.forename: Nelly
authors.initials: N
authors.lastname: Ninis
authors.forename: Rafael
authors.initials: R
authors.lastname: Perera
authors.forename: Richard
authors.initials: R
authors.lastname: Mayon-White
authors.forename: Claire
authors.initials: C
authors.lastname: Phillips
authors.forename: Linda
authors.initials: L
authors.lastname: Bailey
authors.forename: Anthony
authors.initials: A
authors.lastname: Harnden
authors.forename: David
authors.initials: D
authors.lastname: Mant
authors.forename: Michael
authors.initials: M
authors.lastname: Levin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008589:Meningococcal Infections / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D013997:Time Factors