Recognising meningococcal disease in primary care: qualitative study of how general practitioners process clinical and contextual information
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OBJECTIVES: To describe the presentation of meningococcal disease in primary care; to explore how general practitioners process clinical and contextual information in children with meningococcal disease; and to describe how this information affects management. DESIGN: Qualitative analysis of semistructured interviews. SETTING: General practices in South Glamorgan. SUBJECTS: 26 general practitioners who between January 1994 and December 1996 admitted 31 children (under 16 years of age) in whom meningococcal disease was diagnosed. MAIN OUTCOME MEASURES: Categories of clinical rules and techniques used by general practitioners in processing each case. RESULTS: 22 children had rashes; in 16 of them the rashes were non-blanching. When present, a haemorrhagic rash was the most important factor in the doctor's decision to admit a child. 22 children had clinical features not normally expected in children with acute self limiting illnesses--for example, lethargy, poor eye contact, altered mental states, pallor with a high temperature, and an abnormal cry. Contextual information, such as knowledge of parents' consultation patterns and their normal degree of anxiety, played an important part in the management decisions in 15 cases. Use of penicillin was associated with the certainty of diagnosis and the presence and type of haemorrhagic rash. CONCLUSION: The key clinical feature of meningococcal disease--a haemorrhagic rash--was present in only half of the study children. The general practitioners specifically hunted for the rash in some ill children, but doctors should not be deterred from diagnosing meningococcal disease and starting antibiotic treatment if the child is otherwise well, if the rash has an unusual or scanty distribution, or if the rash is non-haemorrhagic.
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The most consistent clinical symptom in ABM is headache; however, no individual symptom can satisfactorily discriminate ABM from other conditions.
“The most consistent clinical symptom in ABM is headache; 4 however, no individual symptom can satisfactorily discriminate ABM from other conditions.30”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [30]
The Introduction says that signs and symptoms of meningococcal disease are often non-specific in primary care, making diagnosis difficult. The Discussion describes widely varying combinations of symptoms in children. These passages support the general diagnostic difficulty, but the paper does not establish that no individual symptom can discriminate acute bacterial meningitis from other conditions. The headache clause is attached to a different citation and is not judged here. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIf blood cultures are taken prior to antibiotic administration, the yield can be as high as 74%.
“If taken prior to antibiotic administration, the yield can be as high as 74%.30”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [30]
The Subjects and methods section mentions blood cultures but gives no yield by timing of antibiotic administration. A search for “74% blood culture positivity” found 74% only in a table of illness duration in the Puzzling findings section, not as a culture yield; the claim is not addressed in our copy. Page numbers were unavailable. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Granier, S., Owen, P., Pill, R., & Jacobson, L.
- Affiliations
- King's College London (GB)
- University of Wales (GB)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1998-01-24
- Volume
- 316
- Issue
- 7127
- Pages
- 276-279
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2665512
- OpenAlex
- W2010148130
- Cited by
- 59
- References
- 18
- Citations by year
- 2026: 1 · 2025: 1 · 2022: 1 · 2021: 2 · 2019: 1 · 2018: 2 · 2016: 3 · 2015: 1 · 2014: 3 · 2013: 2 · 2012: 2
- FWCI
- 3.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Keywords
- meningococcal disease, general practitioners, clinical decision-making, children, clinical features, contextual information, penicillin therapy, diagnosis, primary care management
- MeSH terms
- Adolescent, Child, Child, Preschool, Decision Making, Exanthema, Family Practice, Humans, Infant, Infant, Newborn, Meningococcal Infections, Penicillins, Professional-Family Relations, Referral and Consultation, Wales, Parenting
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