Practice Guidelines

Management of invasive meningococcal disease in children and young people: summary of SIGN guidelines

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.a129 (Published 12 June 2008) Cite this as: BMJ 2008;336:1367
  1. U Theilen, consultant in paediatric intensive care1,
  2. L Wilson, specialist registrar in public health2,
  3. G Wilson, consultant paediatric anaesthetist3,
  4. J O Beattie, consultant paediatrician 4,
  5. S Qureshi, programme director, SIGN5,
  6. D Simpson, consultant in paediatric anaesthesia and intensive care 1
  7. on behalf of the Guideline Development Group
  1. 1Department of Anaesthesia and Paediatric Critical Care, Royal Hospital for Sick Children, Edinburgh EH9 1LF
  2. 2Department of Public Health and Health Policy, University of Glasgow, Glasgow
  3. 3High Dependency Unit, Royal Aberdeen Children’s Hospital, Aberdeen
  4. 4Department of Emergency Medicine, Royal Hospital for Sick Children, Glasgow
  5. 5Scottish Intercollegiate Guideline Network, Edinburgh
  1. Correspondence to: D Simpson dave.simpson{at}luht.scot.nhs.uk

    Why read this summary?

    Despite the successful introduction of immunisation with meningococcal group C conjugate vaccine in 1999,1 invasive meningococcal disease continues to cause substantial morbidity and mortality.2 Most deaths occur in the first 24 hours, often before specialist care starts. The challenge therefore is to identify those patients who will progress rapidly from non-specific early presentation to life threatening disease.3

    Major changes to the organisation of health care in the United Kingdom, particularly in the provision of resuscitation and paediatric intensive care, have been associated with dramatically improved outcomes over recent decades.4 5 However, lack of high quality evidence to inform changes in clinical practice has been a particular challenge in developing this evidence based guideline. This article summarises the most recent guidance from the Scottish Intercollegiate Guidelines Network (SIGN) on the management of invasive meningococcal disease in children and young people.6

    Recommendations

    SIGN recommendations are based on systematic reviews of best available evidence. The strength of the evidence is graded as A, B, C, or D (fig 1), but the grading does not reflect the clinical importance of the recommendations. Recommended best practice (“good practice points”), based on the clinical experience of the guideline development group, is also indicated (as GPP).

    Fig 1 Explanation of SIGN grades of recommendations

    Signs and symptoms

    Invasive meningococcal disease has an early, non-specific stage with signs such as fever, lethargy, irritability, nausea, and poor feeding. These signs are commonly found in children with self limiting viral illnesses, so a confident differential diagnosis at an early stage is very difficult. Observational studies have associated leg pain, cold extremities, and abnormal skin colour with developing invasive meningococcal disease.7 This non-specific early stage commonly lasts for several hours before invasive meningococcal disease progresses rapidly to three general disease patterns8:

    • Clinical meningitis—This is characterised by …

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