Commentary: Controversies in SIGN guidance on management of invasive meningococcal disease in children and young people

BMJ 2008; 336 doi: (Published 12 June 2008) Cite this as: BMJ 2008;336:1370
  1. David Isaacs, professor of paediatric infectious diseases12
  1. 1Department of Infectious Diseases and Microbiology, Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
  2. 2University of Sydney, Sydney, NSW 2006
  1. davidi{at}

It is a moot point whether clinical practice guidelines are of more value if the evidence is strong, rather than weak. Guidelines based on strong evidence may simply reinforce existing knowledge. On the other hand, guidelines based on weak evidence may reassure the clinician, but be of questionable value to the patient. The authors of the guidelines from the Scottish Intercollegiate Guidelines Network (SIGN) claim to be the first to systematically scrutinise the literature to produce evidence based guidelines on recognition and management of meningococcal disease in children, while admitting elsewhere that their task was hampered by a lack of high quality evidence. Any guidelines are only of value if they improve care. With meningococcal infection this means improving mortality and morbidity, which are readily measurable.

A major controversy in childhood meningococcal infection is that the improvement in outcome in UK specialist centres (the case fatality rate at one paediatric intensive care unit …

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