title: Invasive meningococcal disease--improving management through structured review of cases in the Hunter New England area, Australia.
abstract: BACKGROUND
  Invasive meningococcal disease (IMD) is the most common infectious cause of death in childhood in developed countries. This disease may cause severe disability or death if a patient is sub-optimally managed. An audit was performed in Australia of all 2005-06 notified IMD cases to elicit correctable issues.
  
  
  METHODS
  Over the 2 year period, 24 cases were notified in the Hunter New England Health area. These cases were reviewed by an expert panel to highlight key correctable issues in recognition and management of IMD.
  
  
  RESULTS
  The 24 patients were aged between 1 month and 70 years. Thirteen (54%) were children and 14 (58%) were women. Six (25%) cases developed complications, two being severe (one death, one limb amputations). These patients had risk factors for IMD. The emergency department average delay between assessment and administration of antibiotics was 57.8 min.
  
  
  CONCLUSIONS
  There were avoidable factors identified in both patients with a poor outcome. Length of delay in initiating antibiotic therapy has been associated with poor outcome, thus the delay in our series is of concern. The audit highlighted many potentially correctable issues in the medical, laboratory and public health management of IMD cases.
authors.affiliation: Emergency Department, Centre Hospitalier de l'Université Laval, Quebec, Canada. chantal.guimont@crchul.ulaval.ca
authors.forename: Chantal
authors.initials: C
authors.lastname: Guimont
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hullick
authors.forename: David
authors.initials: D
authors.lastname: Durrheim
authors.forename: Nick
authors.initials: N
authors.lastname: Ryan
authors.forename: John
authors.initials: J
authors.lastname: Ferguson
authors.forename: Peter
authors.initials: P
authors.lastname: Massey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D008589:Meningococcal Infections / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D010346:Patient Care Management / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult