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G110(P) A clinical survey to assess attitudes towards the use of lumbar puncture in children with suspected meningitis

Aim Lumbar puncture (LP) is a crucial investigation in the work up of children with suspected meningitis. LP is not always performed when indicated or in accordance with National Institute for Health and Care Excellence (NICE) guidelines. This survey aimed to assess awareness and knowledge of NICE guidelines surrounding the use of LP for suspected bacterial meningitis at a UK paediatric hospital. We aimed to: assess whether doctors would choose to perform an LP when indicated, recognise LP contraindications and make appropriate decisions about LPs in relation to computed tomography (CT) scans. Methods An online survey with four clinical scenarios was sent to clinicians. Clinician data including grade, speciality and training in performing LPs was collected. Results 142 clinicians that would potentially be managing children with meningitis were sent the survey: 66 responded (46%). When LP was indicated (with no contraindications), 60 (91%) respondents stated they would do an LP. Meningococcal shock was recognised by 51 (82%) respondents as a contraindication. In the scenario suggesting the potential presence of an infective space occupying lesion where LP is contraindicated, 49 (80%) correctly identified the need for CT scan before LP. In the final scenario, the child had two contraindications (fluctuating coma score and focal seizure). 33 (56%) of respondents stated they would undertake the LP if the scan was normal. A further 10 stated they would undertake the LP when the coma score improved leaving 16 (27%) who stated they would not do an LP in either of these situations. There was no significant association between grade, speciality, or LP teaching status and adherence to NICE guidelines. 15 respondents (23%) stated they had received LP training in the last 2 years. Conclusions Our survey of attitudes towards the use of LP in children with suspected bacterial meningitis at a paediatric hospital suggests that knowledge for the straight forward cases was good. However, in the more complex cases, there was a hesitancy to undertake an LP even with an improving patient condition and normal imaging. Specific LP training was limited: this could be an area to focus for improving patient management.