Incidence and outcomes of meningitis claims

meningococcal meningitis

Meningitis is a rare disease and notoriously difficult to distinguish from other illnesses in its early stages. Dr Sharmala Moodley, deputy head of claims at the MDU, discusses the incidence and outcomes of meningitis claims.

With an incidence of approximately three cases per 100,000 people each year, meningitis will present just once or twice in the average GP's career. Successful immunisation campaigns have reduced its incidence further, and it is conceivable that in future many GPs may never see a case in their clinical practice.

However rare the condition, a failure to diagnose can have devastating consequences. The patient may not survive, and many who do suffer catastrophic brain and limb damage.

This is one of the main reasons negligence claims involving meningitis are brought, and compensation can run into millions of pounds, especially where a young child requires life-long care.

General practitioners see a large number of febrile young children and unwell adults. The early features of meningitis are often the same as those of minor viral illnesses, of which children are likely to develop several in the first two years of life. By the time a doctor sees the patient, the symptoms may still be indistinguishable from other more common conditions and these diseases do tend to progress very rapidly.

The warning symptoms and signs differ depending on the age of the child. It is because the outcome for the patient is so devastating that there can be a tendency to assume, with hindsight, that it could have been different. Our experience of defending meningitis claims is that information in the records is often incomplete and there is generally a dispute of facts.

In a review of selected settled meningitis claims against our members, the principal conclusion is that a fuller clinical note of the history and examination findings along with documentation of the follow-up advice given may make it easier to defend a claim.

In the cases reviewed, the factual dispute always related to the clinical condition of the patient at the time they were seen by the doctor. Other areas where the doctor was vulnerable to criticism included:

  • note keeping, in particular failure to record negative findings, including state of alertness and photophobia
  • failure to document the patient's temperature
  • lack of safety netting advice.

Without these vital pieces of information, it becomes difficult to establish the exact clinical sequence of events, which in turn impacts on the determination of breach of duty and causation, as the case studies that follow show.

Learning points

  • Practitioners often note that a child is well. This is a subjective assessment. In clinical negligence cases, experts and judges prefer a more objective analysis.
  • Where there is a factual dispute, the documentation of objective findings helps establish the clinical condition of the child at the time of the consultation.
  • Documentation of the patient's state of alertness, colour, temperature, respiratory rate and capillary refill (as set out in the NICE feverish illness in children guidance), along with negative findings, may not assist in the diagnosis of meningitis but may help in the defence of a claim.
  • Consideration should also be given to recording negative findings and safety netting advice about follow-up arrangements.
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This page was correct at publication on . Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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