[Diagnostic problems of purulent meningitis in children in general practice].

Previous investigations have demonstrated that considerable problems may exist in the diagnosis of purulent meningitis (PM) in general practice. Referrals from general practitioners/duty roster doctors concerning 97 children discharged the diagnosis of PM were reviewed retrospectively. The patients were subdivided into two groups according to whether the diagnosis was established by the referring doctor or not. Only 35% of the children under one year were admitted for suspected PM, whereas 65% of the children between one year and 15 year were hospitalized with the correct diagnosis. The commonest positive findings in both age groups were alterations in consciousness which were found in more than 80% of the children. Children in whom the diagnosis was not established by the referring doctor had fewer classical signs of meningitis (neck-stiffness, Kernig's sign, bulging fontanelle and petecchia) than children in whom the diagnosis was established. Children with negative cultures from the cerebro-spinal fluid were significantly more frequently treated with antibiotics prior to hospitalization. Approximately half of the children admitted with suspected meningitis were not treated according the guidelines issued by the Danish Board of Health, without this having any effect on the survival rate.