Monitoring

In hospital

Measure and record the following at least every hour, in line with local protocols and/or your institution’s recommended early warning or risk stratification system:[50][81]

  • Heart rate

  • Respiratory rate and extent of respiratory distress

  • Oxygen saturations

  • Blood pressure

  • Temperature

  • Perfusion (capillary refill)

Neurological assessment (such as the Alert, Voice, Pain, Unresponsive [AVPU] scale).

Be aware that children and young people with bacterial meningitis (particularly meningococcal meningitis) can deteriorate rapidly regardless of the results of any initial assessment of severity. Escalate early.

In adults, involve intensive care teams early in patients with:[49]

  • Rapidly evolving rash

  • Evidence of limb ischaemia

  • Cardiovascular instability

  • Acid/base disturbance

  • Hypoxia

  • Respiratory compromise

  • Frequent seizures

  • Altered mental state

Transfer patients to critical care if they:[49]

  • Have a rapidly evolving rash

  • Have a Glasgow Coma Scale score of ≤12 or drop of >2 points​ [ Glasgow Coma Scale Opens in new window ]

  • Require monitoring or specific organ support

  • Have uncontrolled seizures

  • Have evidence of sepsis

Ensure all patients with meningitis and meningococcal sepsis receive input from an infectious disease or microbiology specialist.[49]

Long-term

Offer a formal audiological assessment as soon as possible, within 4 weeks of being fit to test, and preferably before discharge from hospital.[48]​​

If the child or young person has severe or profound deafness, offer an urgent assessment for cochlear implants as soon as they are fit to undergo testing.[48]​ See Assessment of hearing loss.

Ensure children and young people are reviewed by a paediatrician (with the results of their hearing test) 4-6 weeks after hospital discharge to discuss morbidities associated with their condition and be offered referral to appropriate services.[48]​​

Although formal testing for cognitive, academic, and behaviour problems is not generally necessary, it is important to monitor the child's progress over time. All patients should be reviewed once a year to detect any long-term complications.

As with all patients who survive bacterial meningitis, patients with meningococcal meningitis are at risk for long-term neurological sequelae.

Use of this content is subject to our disclaimer