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Bacterial conjugate vaccines have dramatically changed the epidemiology of childhood meningitis; viral causes are increasingly predominant, but the current UK epidemiology is unknown. This prospective study recruited children under 16 years of age admitted to 3 UK hospitals with suspected meningitis. 70/388 children had meningitis-13 bacterial, 26 viral and 29 with no pathogen identified. Group B Streptococcus was the most common bacterial pathogen. Infants under 3 months of age with bacterial meningitis were more likely to have a reduced Glasgow Coma Score and respiratory distress than those with viral meningitis or other infections. There were no discriminatory clinical features in older children. Cerebrospinal fluid (CSF) white blood cell count and plasma C-reactive protein at all ages, and CSF protein in infants <3 months of age, distinguished between bacterial meningitis and viral meningitis or other infections. Improved diagnosis of non-bacterial meningitis is urgently needed to reduce antibiotic use and hospital stay.

Aim Attendances to emergency departments (EDs) in the UK are increasing, particularly for younger children. Community services are under increasing pressure and parents may preferentially bring their babies to the ED, even for non‐urgent problems. This study aimed to characterise the presenting features, management and disposition of neonatal attendances to a children's ED (CED). Methods Retrospective observational review of neonatal attendances (≤28 days) to the CED at Bristol Royal Hospital for Children (BRHC) from 01/01/2016 to 31/12/2016. Further information was obtained from investigation results and discharge summaries. Data abstracted included sex, age, referral method, presenting complaint, diagnosis, investigations and treatments. Results Neonatal attendances increased from 655 to 1,205 from 2008 to 2016. The most common presenting complaints were breathing difficulty (18.1%) and vomiting (8.3%). The most common diagnoses were ‘no significant medical problem’ (41.9%) and bronchiolitis (10.5%). Half of neonatal attendances to the CED had no investigations performed and most (77.7%) needed advice or observation only. Conclusion Many neonates presenting to the CED were well and discharged with observation only. This suggests potential for improving community management and in supporting new parents. Drivers of health policy should consider developing enhanced models of out of hospital care which are acceptable to clinicians and families.

Introduction Triage is a key principle in the effective management of major incidents, yet there is a paucity of evidence surrounding the optimal method of paediatric major incident triage (MIT). This study aimed to derive consensus on key components of paediatric MIT among healthcare professionals involved in the management of paediatric major incidents. Methods This modified two-round online Delphi consensus study, delivered between July and October 2021, included participants from pre-hospital and hospital specialities involved in managing a paediatric major incident. Statements were derived iteratively based on review of MIT tools, and extant literature. A 5-point Likert agreement scale was used to determine consensus, which was set a priori at 70%. Results 111 clinicians completed both rounds, with 13 of 17 statements reaching consensus. Positive consensus was reached on the use of rescue breaths in mechanisms associated with hypoxia or asphyxiation, use of mobility assessment as a crude discriminator of injury, and use of adult physiology for older children. Whilst positive consensus was reached on the benefits of a single MIT tool for use across the entire adult and paediatric age range, there was negative consensus in relation to the clinical implementation of such a tool. Consensus could not be reached regarding the use of a single tool across the whole paediatric age range specifically, nor on the use of rescue breaths in blunt or penetrating trauma. Conclusion This Delphi study has established consensus among a large group of subject matter experts on several key elements of paediatric MIT. Further work is required to develop a triage tool that can be implemented based on emerging and ongoing research, and which is acceptable to clinicians.