Determinants of timely management of acute bacterial meningitis in the ED

Schuh, Sabine K.; Lindner, Gregor; Exadaktylos, Aristomenis K.; Mühlemann, Kathrin; Täuber, Martin G.

doi:10.1016/j.ajem.2013.03.042

Cited by 16 publications

(8 citation statements)

References 16 publications

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“…CL, centerline; LCL, lower control limit; UCL, upper control limit. The average time of 130 ± 76 minutes to the first dose of antibiotic in this study was similar to the findings of mean duration to the antibiotic from the arrival of 136 ± 132 minutes in patients with bacterial meningitis and 184 ± 222 minutes in those with no meningitis in the study by Schuh et al 21 Other studies in different age groups and clinical settings also highlighted similar delay to prompt treatment of suspected infections in different age groups and care settings. 1,2,20 Therefore, applying the process improvement principles highlighted in this study will be useful in other pediatric care settings to mitigate the delay to prompt medication administration.…”

Section: Discussionsupporting

confidence: 89%

Reducing Time to First Dose of Antibiotic: The Example of Asymptomatic Neonates Exposed to Chorioamnionitis

Ajayi

Kehinde

Cooperberg

et al. 2021

Pediatric Quality &Amp; Safety

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Introduction: Time of medication delivery from the onset of illness is one factor that determines disease outcomes. In this study, we aimed to reduce the average time from admission to the first dose of antibiotic by at least 30% and increase the percentage of neonates receiving the first antibiotic dose within 1 hour of neonatal intensive care unit arrival to 50% over 12 months in asymptomatic neonates 34 weeks and older estimated gestational age with exposure to maternal chorioamnionitis as a sample population. Method: This study involved 135 infants 34 weeks and older gestational age exposed to chorioamnionitis. We documented the demographic characteristics of mothers and infants. We monitored time to the administration of the first dose of antibiotics through multiple plan-do-study-act cycles. We identified barriers to timely antibiotic administration and targeted them with multipronged interventions in plan-do-study-act cycles. Process measures were displayed monthly using X-bar/S control charts and P charts. We applied established rules for detecting a special cause. Results: We reduced the meantime to the first dose of antibiotics from 130 to 78 minutes (40% reduction). The percentage of infants who received the first antibiotic dose within 60 minutes rose from 5.8% to 36.3% during the study period. Special cause improvement was seen in all process measures. The most significant improvement seen was in the time to obtain a blood culture and the interval between intravenous access placement and antibiotic delivery. Conclusion: Multipronged interventions can help improve timely medication delivery to neonates in the neonatal intensive care unit in this example of infants exposed to chorioamnionitis.

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Section: Discussionsupporting

confidence: 89%

Reducing Time to First Dose of Antibiotic: The Example of Asymptomatic Neonates Exposed to Chorioamnionitis

Ajayi

Kehinde

Cooperberg

et al. 2021

Pediatric Quality &Amp; Safety

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“…Diagnostic difficulty of ABM in the elderly is attributed to its atypical and more subtle presentation [ 10 , 46 ]. It has been shown that the time from arrival to starting antibiotic is longer among those patients with suspected meningitis who had atypical presentation or complex medical histories [ 47 ]. Another major problem in attaining a correct diagnosis in the elderly is the presence of multiple pathologies.…”

Section: Methodsmentioning

confidence: 99%

The Optimal Management of Acute Febrile Encephalopathy in the Aged Patient: A Systematic Review

Sheybani

Naderi

Sajjadi

2016

Interdisciplinary Perspectives on Infectious Diseases

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The elderly comprise less than 13 percent of world population. Nonetheless, they represent nearly half of all hospitalized adults. Acute change in mental status from baseline is commonly seen among the elderly even when the main process does not involve the central nervous system. The term “geriatric syndrome” is used to capture those clinical conditions in older people that do not fit into discrete disease categories, including delirium, falls, frailty, dizziness, syncope, and urinary incontinence. Despite the growing number of elderly population, especially those who require hospitalization and the high burden of common infections accompanied by encephalopathy among them, there are several unresolved questions regarding the optimal management they deserve. The questions posed in this systematic review concern the need to rule out CNS infection in all elderly patients presented with fever and altered mental status in the routine management of febrile encephalopathy. In doing so, we sought to identify all potentially relevant articles using searches of web-based databases with no language restriction. Finally, we reviewed 93 research articles that were relevant to each part of our study. No prospective study was found to address how should AFE in the aged be optimally managed.

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“…Conventional methods to con rm hypovolemia, such as hemoglobin and hematocrit measurements, are not always available at point-of-care, and hemodynamic monitoring may not detect relevant blood loss. If treatment is delayed because of delayed laboratory results or diagnostic studies, patient outcomes may be negatively impacted [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Non- Invasive Hemoglobin and Venous Blood Gas Hemoglobin Measurements in Comparison with Laboratory Method in Intensive Care Unit

SOBH,

ALSOOFI,

ALATEFI

et al. 2023

Preprint

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Background: Continuous real time monitoring of hemoglobin (Hb) may provide clinical valuable information to guide blood transfusion decisions in the intensive care unit (ICU). This study was designed to evaluate non-invasive hemoglobin (SpHb) and venous blood gas (VBGHb) measurement accuracy in comparison to laboratory hematology measurement (LabHb) in ICU. Methods: With each blood gas analysis, SpHb was recorded, and venous blood Hb was measured by hematology (LabHb) and blood gas CO-Oximetry (VBGHb). Results: Compared to LabHb, SpHb showed small bias with better limits of agreement than VBGHb. Mean bias (95% limits of agreement) for SpHb was -0.0557 (-0.5614 to 0.4499) gm/dL and for VBGHb was -0.4734 (-2.8312 to 1.8844). Also for trend accuracy, Modified Bland–Altman analysis showed small bias with better limits of agreement for SpHb trends compared to VBGHb trends. Mean bias (limits of agreement g/dl) for SpHb was -0.0102 (− 0.6317 to 0.6113); for VBGHb was 0.0136 (− 3.5733 to 3.5461). Conclusion: We concluded that Non-invasive hemoglobin (SpHb) showed acceptable absolute and trend accuracy and excellent correlation with Lab-Hb, which provides an easy, feasible and accurate solution for Hb measurement in ICU.

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Determinants of timely management of acute bacterial meningitis in the ED

Cited by 16 publications

References 16 publications

Reducing Time to First Dose of Antibiotic: The Example of Asymptomatic Neonates Exposed to Chorioamnionitis

Reducing Time to First Dose of Antibiotic: The Example of Asymptomatic Neonates Exposed to Chorioamnionitis

The Optimal Management of Acute Febrile Encephalopathy in the Aged Patient: A Systematic Review

Accuracy of Non- Invasive Hemoglobin and Venous Blood Gas Hemoglobin Measurements in Comparison with Laboratory Method in Intensive Care Unit

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