Audit of suspected meningitis in a district in 1996-1997 and in 1999.

The Public Health Laboratory Service has published guidance outlining appropriate investigations and public health action to control the spread of meningococcal disease. We investigated compliance with this guidance in audits of suspected meningitis cases in our district notified to the public health department between January 1996 and December 1997, and in 1999. The total number of suspected meningitis cases in 1996-7 and in 1999 were 58 and 34 respectively. Meningococcal disease was suspected in 49 and 28 patients respectively, and for 58 (75.3%) of these case notes were found. Rash was more often a presenting sign in 1999. The second audit also showed a non-significant reduction in the proportion of patients given penicillin before hospital admission (22.4% vs. 7.1%, p = 0.12), and in CSF microscopy requests (31% vs. 17.6%, p < 0.5). Requests for meningococcal investigation by blood culture (77.5% vs. 79.4%, p < 0.5) blood PCR (34.5% vs. 64.7%, p < 0.001) and throat swab (25.9% vs. 55.9%, p < 0.005) were increased. Notifications of cases to the public health department within 24 hours of admission were also increased slightly (42.8% vs. 52.9%; p < 0.5). Changes in clinical practice can be achieved through guidelines, audit and feedback. The importance of parenteral penicillin administration prior to hospital admission, appropriate investigations and prompt public health notification should be re-emphasised.