Primary diagnosis in a life-threatening childhood infection. A nationwide study on bacterial meningitis.

The accuracy of primary diagnosis made by general practitioners and paediatric house officers was assessed from a nationwide series of 130 Finnish children with bacterial meningitis. Meningitis was diagnosed at the first medical examination in 76 (58%) of the cases (32/70, 46% at physician's office versus 44/60 (73%) in hospital emergency rooms; p less than 0.005). In 44 cases (34%), there was a time lapse (mean, 1.7 days) between the first examination and the diagnosis of bacterial meningitis. In 30 of them, no findings suggestive of bacterial meningitis were present during the initial examination, whereas a definite or probable iatrogenic diagnostic delay occurred in 14 cases (11%). One of the latter children died and 2 recovered with major neurological handicaps. The overall mortality rate was 5/130 (4%) and the frequency of neurological sequelae was 28/130 (22%). The existence of potentially avoidable diagnostic delay in childhood bacterial meningitis was confirmed. Means of avoiding such potentially disastrous delay were discussed briefly.