Patients with suspected meningitis: A study in general practice

To assess the management of patients with suspected meningitis by general practitioners, we used data from the Dutch National Survey of Morbidity and Interventions in General Practice. In this study, involving 161 general practitioners with a practice population of 335,000 persons, all patient contacts in general practice and all hospital admissions were registered. Additional information was gathered by interviewing the GPs involved. We selected patients with a provisional diagnosis of meningitis by the GP and/or a hospital diagnosis of meningitis. Of the 17 patients with the provisional diagnosis of meningitis by the GP eight had a final diagnosis of meningitis (predictive value of the provisional diagnosis: 46% In the majority of patients with another final diagnosis the GP reported meningeal irritability and lowered consciousness, but this was not confirmed in hospital. Of all ten patients with a final diagnosis of meningitis eight had the correct provisional diagnosis of meningitis by the GP (sensitivity of the provisional diagnosis meningitis: 80% We conclude that it is often difficult to diagnose meningitis in general practice. Inevitably, patients will be referred with a provisional diagnosis of meningitis which cannot be confirmed in hospital.