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Dramatic drop in meningitis deaths at St Mary's hospital, Paddington


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External Sites:
-St Mary's NHS Trust web site
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Strict embargo: 00.01 hours Monday 22 October (pre-filming/interviews/photography can be arranged. Please see Notes to Editors)

New research shows that the death rate in critically ill children suffering with meningitis and referred to St Marys in Paddington from hospitals in the South East has plummeted from 23 to 6 per cent, despite the severity of the disease remaining the same.

These children had the severest form of meningococcal disease, where the death rate nationally still stands between 20 and 50 per cent. The drop was monitored over a five year period to 1997.

Imperial College doctors at St Marys are putting the success down to the centralisation of cases at the hospitals specialist paediatric intensive care unit (PICU), early interaction between the specialist centre and local hospitals, and the use of a mobile intensive care team sent out to local NHS hospitals for each critically ill child.

Research published in this months journal of the British Medical Journal Publishing group, Archives of Disease in Childhood, studied the outcome of 331 children admitted with severe meningococcal disease (meningitis and septicaemia) to the PICU between 1992 when it first opened, and 1997. The children were aged between five weeks and 18 years.

All children were either admitted directly to the PICU, or were brought in from 80 NHS hospitals in the South East.

The children admitted to intensive care at St Marys have the severe form of the disease, where death rates can still be higher than 50 per cent. Doctors believe the factors implicated in decreasing mortality at the hospital include:

  • Increased awareness of the disease by parents and health care professionals
  • The increased use of penicillin by GPs
  • Better resuscitation techniques in local hospitals
  • The centralisation of care in a specialist unit with a commitment to out-reach education and disseminating guidelines
  • A specialist inter-hospital transfer service and improvements in the management of multi-organ failure.

Michael Levin, Imperial College Professor of Paediatrics at St Marys Hospital, said: "Despite the introduction of a successful vaccine against one strain of the disease, meningococcal meningitis and septicaemia continues to affect around 2,000 children a year and claims over a 100 lives in the UK.

"With meningococcal disease time is of the essence, which is why our work with local hospitals and primary care colleagues has been key to the success. Real time advice on immediate clinical management when the child first arrives at their local hospital means that resuscitation and stabilisation efforts can be started even before arrival of our mobile intensive care team there."

Doctors believe the dramatic decrease in mortality makes a strong case for implementing this model of care more widely, where all critically ill children gain swift access to specialist intensive care facilities.

-ends-

Notes to Editors

Filming/interview requests

Doctors at the Paediatric Intensive Care Unit (PICU) are available from Friday 19 October 2001, as long as the publishers embargo is respected. Emma Kane, the mother of four-year-old Patrick who was rushed to the PICU in January 1998 suffering with meningococcal septicaemia, is also available for interviews and filming. Patrick suffered multi-organ failure as a result of the disease, and Emma believes it is thanks to the units quick responsiveness that he is alive and well today. Emma can be contacted via Claire Burroughs (see details below).

Contacts

Dr Joseph Britto
Consultant in Paediatric Intensive Care
St Marys NHS Trust
T. 020 7886 6077
Pager 020 8345 6789, ask for call sign H4416

Claire Burroughs
PR/Communications Manager
St Marys NHS Trust
T. 020 7886 6704
Pager 07693 379366 (for out of hours)

Background to St Marys PICU

1. The paper Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery is peer reviewed and appears in the latest edition of Archives of Disease in Childhood. This is published by the British Medical Journal Publishing group.

2. St Marys Hospitals Paediatric Intensive Care Unit (PICU) was first opened in 1992 with 2 beds. The PICU now has 8 beds and has cared for over 2,300 critically ill children since 1992, now seeing over 500 cases each year. The unit transfers and admits critically ill children with various life-threatening medical and surgical conditions.

3. The clinical work of the unit is closely linked to the academic department of Paediatrics at Imperial College. The Meningococcal Meningitis Research Group was established in 1990 under the Professorship of Mike Levin. The research in the department focuses primarily on paediatric infectious diseases including meningitis, HIV, Kawasakis disease and tuberculosis in children. The team are at the forefront of research and publish their results regularly in international peer reviewed medical journals.

4. The PICU at St Marys employ 25 doctors and 50 nurses. It plays a key role in the development of St Marys as West Londons centre for specialist acute childcare, with neuro-muscular services and BMT transferring from the Hammersmith Hospital earlier this year, and the opening of a dedicated Childrens Accident and Emergency Department in 2000.

5. The Department of Health introduced a conjugate vaccine (effective in infants) against group C meningococcal disease in November 1999. Following the introduction there has been a dramatic decrease in the number of cases of meningococcal disease caused by group C. Group B meningococcal disease remains a huge public health problem. There are about 2,600 cases of meningococcal disease each year in the UK. Whilst the mortality rate across the country is down to 6 per cent, the mortality rate of children with the severest form of the disease, admitted to intensive care is over 50%. The need for vigilance, awareness and support for specialist paediatric intensive care facilities remains as important as ever.

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