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National Collaborating Centre for Women's and Children's Health (UK). Bacterial Meningitis and Meningococcal Septicaemia: Management of Bacterial Meningitis and Meningococcal Septicaemia in Children and Young People Younger than 16 Years in Primary and Secondary Care. London: RCOG Press; 2010. (NICE Clinical Guidelines, No. 102.)

8References, glossary and abbreviations

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Abbreviations

ACTH

adrenocorticotropic hormone

ADH

antidiuretic hormone

ADHD

attention deficit hyperactivity disorder

AM

aseptic meningitis

aPC

activated protein C

APLS

advanced paediatric life support

AUC

area under the curve

AVPU

alert, voice, pain unresponsive

bexA

Haemophilus influenzae or Bacillus influenzae

BM

bacterial meningitis

BNF

British National Formulary

BNFC

British National Formulary for Children

BPI

bacterial permeability increasing protein

Chi2

Chi-square distribution

CI

confidence interval

CINAHL

Cumulative Index to Nursing and Allied Health Literature

CMO

chief medical officer

CNS

central nervous system

CRP

C-reactive protein

CSF

cerebrospinal fluid

CT

cranial computed tomography

ctrA

N. meningitidis capsular transfer

D

day

dB HL

decibel of hearing loss

df

degrees of freedom

DOR

diagnostic odds ratio

EBSCO

Elton B. Stephens Company

EDTA

ethylenediaminetetraacetic

EI

extrameningeal bacterial infection

EL

evidence level

g

gramme

GCSE

General Certificate of Secondary Education

GDG

Guideline Development Group

GMSPS

Glasgow meningococcal septicaemia prognostic score

GP

general practitioner

h

hour

Hib

Haemophilus influenzae type b

HPA

Health Protection Agency

HRG

Healthcare Resource Group

HSV

herpes simplex virus

HUI-3

Health Utilities Index Mark 3

ICER

incremental cost-effectiveness ratio

ICP

intercranial pressure

ICU

intensive care unit

IMD

invasive meningococcal disease

IQ

intelligence quotient

IQR

interquartile range

IV

intravenous

kg

kilogramme

kPa

kiloPascal

LR

likelihood ratio

m

month

mABC

movement assessment battery for children

menC

meningococcal C

mg

milligramme

MHRA

Medicines and Healthcare products Regulatory Agency

ml

millilitre

mm

millimetre

mmHg

millimetre of mercury

mmH2O

millimetre of water

mmol

millimole

MOC

MenOPP bedside clinical

MSS

meningococcal septic shock

n

number

NDCS

National Deaf Children’s Society

ng

nanogrammes

NHS

National Health Service

NHS EED

National Health Service Economic Evaluation Database

NICE

National Institute for Health and Clinical Excellence

NK

not known

NPSA

National Patient Safety Agency

NPV

negative predictive value

ns

not significant

OME

otitis media with effusion

ONS

Office for National Statistics

OR

odds ratio

PaCO2

pressure of carbon dioxide

PaO2

pressure of oxygen

PCR

polymerase chain reaction

PICU

paediatric intensive care unit

Ply

Streptococcus pneumonia

py

pneumolysin gene

PMN

polymorphonuclear

PPV

positive predictive value

PRISM

Pediatric Risk of Mortality

PSSRU

Personal Social Services Research Unit

QALY

quality adjusted life year

QoL

quality of life

RBC

red blood cell

RCPCH

Royal College of Paediatrics and Child Health

RCT

randomised controlled trial

rBP121

recombinant bactericidal permeability-increasing protein

RR

relative risk

SD

standard deviation

SIADH

syndrome of inappropriate antidiuretic hormone secretion

SIGN

Scottish Intercollegiate Guidelines Network

se

sensitivity

sp

specificity

SPC

summary of product characteristics

SpO2

oxygen saturation

TA

technology appraisal

TB

tuberculosis

UK

United Kingdom

UM

undetermined meningitis

USA

United States of America

UTI

urinary tract infection

+ve

positive

-ve

negative

VM

viral meningitis

WBC

white blood cell

WMD

weighted mean difference

WTP

willingness to pay

y

year

Glossary of terms

Adjunctive therapy

The use of one medication to improve response or help decrease some of the side effects of another medication.

Antidiuretic hormone (ADH)

Also known as vasopressin, a hormone secreted by the posterior pituitary gland which helps the body conserve the right amount of water. ADH prevents the production of dilute urine (and so is antidiuretic).

Antigen

Any substance that may be specifically bound by any antibody molecule.

Apnoea

A temporary stopping or interruption to breathing.

Bacterial meningitis

Bacterial infection of the meninges.

Band form

An immature polymorphonuclear leukocyte (neutrophil).

Bolus

A volume of fluid given quickly.

Brudzinski’s sign

With the patient supine, the physician places one hand behind the patient’s head and places the other hand on the patient’s chest. The physician then raises the patient’s head (with the hand behind the head) while the hand on the chest restrains the patient and prevents them from rising. Flexion of the patient’s lower extremities (hips and knees) constitutes a positive sign.

Capillary refill time (CRT)

A test performed on physical examination in which the skin is pressed until blanched by the clinician’s finger and the time taken for the skin to return to its previous colour is measured. CRT can be measured peripherally (on the extremities) or centrally (on the chest wall). A prolonged CRT may be a sign of circulatory insufficiency (such as shock) or dehydration.

Cerebral oedema

Swelling of the brain.

Cerebrospinal fluid (CSF)

The watery fluid that surrounds the brain and spinal cord. Samples of CSF can be obtained by lumbar puncture.

Circulatory failure

The inability of the cardiovascular system to adequately supply oxygenated blood to the tissues. This can be caused by shock.

Coagulopathy

A condition affecting the blood’s ability to form a clot.

Cold shock

Cold shock is shock in children with sepsis associated with vasoconstriction in the skin and peripheries.

Colloid solution (including synthetic colloids)

Colloid solutions contain substances of high molecular weight that do not readily migrate across capillary walls. By increasing osmotic pressure within the bloodstream, colloids draw fluid in from other compartments to increase the vascular volume. Plasma and plasma substitutes are known as colloids and they contain large molecules that do not readily leave the intravascular space where they exert osmotic pressure to maintain circulatory volume. Examples are albumin, hetastarch, dextran and gelofusine.

Albumin provides about 80% of the plasma colloid osmotic pressure in healthy adults. Albumin for therapeutic uses is prepared from donor plasma. Normal human serum albumin is available as 4–5% or 15–25% solutions: 5% albumin solution is osmotically and oncotically equivalent to plasma whereas 25% albumin solution is hyperoncotic. The major clinical use of albumin is as a volume expander in the treatment of shock caused by blood or plasma loss.

Plasma substitutes (dextrans, gelatine and the etherified starches) are macromolecular substances which are metabolised slowly. They may be used at the outset to expand and maintain blood volume in shock.

Co-morbidity

Co-existence of a disease or diseases in the people being studied in addition to the health problem that is the subject of the study.

Complement system

A series of enzymes present in the blood that, when activated, produces widespread inflammatory effects and directly destroys micro-organisms.

Conjugate vaccine

A vaccine in which two different antigens are joined together (conjugated) to improve the immune response. Typically, this means conjugating a polysaccharide antigen to a protein antigen to improve the antibody response to the polysaccharide antigen, for example as with the recent pneumococcal polysaccharide–protein conjugate vaccine.

Corticotropin test

The short corticotropin stimulation test is widely used to assess adrenocortical function in critically ill patients.

C-reactive protein (CRP)

A plasma protein that circulates in increased amounts during inflammation and after tissue damage. Measurement of CRP in blood samples is widely used as a marker of infection or inflammation.

Crystalloid solution

Intravenous fluids made up of water with various dissolved salts and sugars.

Cytokine

A member of a large family of proteins that are important for immunity and inflammation and that act on the effector cells of the immune system.

Dengue haemorrhagic fever

A severe manifestation of infection with the tropical mosquito-borne Dengue virus, characterised by haemorrhagic lesions of the skin, reduced platelet count and leakage of the fluid part of blood into the tissues.

Doll’s eye movements

When the head is moved from side to side, the eyes remain fixed in midposition, instead of the normal response of moving laterally toward the side opposite to the direction the head is turned.

Ecchymoses

An ecchymosis is a non-blanching area of skin caused by loss of blood from a blood vessel. In simple terms it appears like a bruise. It implies a larger size than a petechial spots and has a more diffuse border than purpuric spots. It can be caused by a bruise (which implies trauma), but can also be caused by a bleeding problem. Ecchymoses can similarly occur in mucous membranes, for example in the mouth.

Empiric antibiotic

Antibiotic that treats a wide spectrum of microorganisms. Empiric antibiotics are used before the specific organism is known. Once this is known, a more specific antibiotic can be given.

Encapsulated bacteria

Bacteria surrounded by a sugar (polysaccharide) coat, for example the bacteria causing meningitis that are discussed in this guideline.

Endothelial cell

Endothelial cells are thin flat cells which line the inside of all blood vessels from the heart to the capillaries. They have structural and metabolic roles.

Endotoxin

These are chemicals that are released by bacteria and can cause some of the damaging effects of infections. The endotoxins of some bacteria can cause cells to break down, which can, in the most severe cases, cause shock from septicaemia. Endotoxins can also interfere with the body’s response to fighting infections.

End-tidal capnography

A device that allows non-invasive measurement of exhaled carbon dioxide.

Epidemiology (for instance of bacterial meningitis)

The branch of medical science dealing with the transmission and control of disease.

External validity

The degree to which the results of a study hold true in non-study situations, such as in routine clinical practice. May also be referred to as the generalisability of study results to non-study patients or populations.

Extrapolation

The application of research evidence based on studies of a specific population to another population with similar characteristics.

Extravasation

The leakage of intravenous drugs from the vein into the surrounding tissue.

Focal neurological deficit

A finding on physical examination of a deficiency or impairment of the nervous system that is restricted to a particular part of the body or a particular activity. A focal neurological deficit is caused by a lesion in a particular area of the central nervous system. Examples include weakness of a limb or cranial nerve palsy. These signs suggest that a given disease process is focal rather than diffuse.

Fontanelle

A membrane-covered gap or soft spot between the skull bones on the top of an infant’s skull near the front. A bulging fontanelle can be a sign of meningitis.

Generalisability

The extent to which the results of a study hold true for a population of patients beyond those who participated in the research. See also generalisability of study results to non-study patients or populations.

Gold standard

A method, procedure or measurement that is widely accepted as being the best available.

Herd immunity

The development of immunity for all of the community (or ‘herd’), including for unvaccinated individuals, that occurs when a sufficient number of other individuals in the community have been vaccinated.

Hyperdynamic shock

‘Warm shock’ hypotension, vasodilation, normal or increased cardiac output.

Hyponatraemia

An electrolyte disturbance in which the sodium concentration in the plasma is too low (below 135 micromole/litre).

Ill appearance

An ill-looking child is an overall impression the assessing healthcare professional can make when presented with a child or young person. This impression is formed not only from objective measurements but also from subjective feelings about how the child looks and reacts.

If a healthcare professional’s subjective instinct is to describe the child as ‘ill-looking’ then the child is most likely at high risk of serious illness. Healthcare professionals should be confident to follow their impressions of a child’s wellbeing.

Inotrope

A medication used to strengthen the cardiac muscular contractions and improve blood circulation.

Intraosseous infusion

Injection of fluid directly into the bone marrow.

Isotonic fluid

Solution that has the same salt concentration as the normal cells of the body and the blood.

Kernig’s sign

Extension of the knees is attempted: the inability to extend the knees beyond 135 degrees without causing pain constitutes a positive test for Kernig’s sign.

Leucocyte count

The number of white blood cells per unit volume in venous blood. A differential leucocyte count measures the relative numbers of the different types of white cell.

Lumbar puncture

A procedure in which cerebrospinal fluid is obtained by inserting a hollow needle into the space between vertebrae in the lumbar region of the spine. The procedure is used to diagnose meningitis and encephalitis.

Mannan binding lectin

Mannose binding lectin (MBL), also named mannose- or mannan-binding protein (MBP), is an important factor in innate immunity.

Meningism

Stiffness of the neck associated with backwards extension of the cervical spine.

Meningitis

Inflammation of the meninges, the membranes that lie between the surface of the brain and the inside of the skull. Meningitis is usually caused by infection with bacteria or viruses. Bacterial meningitis is a serious condition associated with appreciable mortality and significant neurological complications.

Meningococcal disease

Any of a number of infections caused by the bacterium Neisseria meningitidis (also known as meningococcus). In young children meningococcal disease usually manifests as septicaemia, meningitis or a combination of the two. Meningococcal septicaemia is the leading infectious cause of death in childhood in the UK.

Meningococcal septicaemia

Systemic meningococcal infection (with or without circulatory failure) without clinical meningitis. This is a serious medical condition in which there is rapid multiplication of bacteria in the bloodstream and in which bacterial toxins are present in the blood. Septicaemia is usually fatal unless treated promptly with parenteral antibiotics.

Meningoencephalitis

Meningitis plus encephalitis: inflammation of the meninges and the brain.

Microbial resistance

The ability of microorganisms to withstand an antibiotic to which they were once sensitive.

Microbial sensitivity

The susceptibility of microorganisms to antibiotics.

Minimum inhibitory concentration

The minimum inhibitory concentration is the lowest concentration of an antimicrobial agent that will inhibit the visible growth of a microorganism after overnight incubation in the laboratory. They are important measures in diagnostic laboratories as they show whether the organism in question is resistant to an antimicrobial agent.

Moribund

A condition where the individual is close to death.

Neonate

A newly born baby aged less than 28 days.

Neutrophils

A type of white blood cell, also called polymorphonuclear leucoytes.

Paediatric intensivist

A specialist in paediatric intensive care medicine.

Parenteral antibiotic

An antibiotic given by a route other than by mouth, usually by intravenous or intramuscular injection.

PCR Elisa

A capture assay for nucleic acids that mimic enzyme linked immunosorbant assays. In this assay, PCR products hybridized to an immobilized capture probe.

Petechiae

These are small pinprick-sized (less than 2 mm diameter) and pinprick-appearing purple spots. They are non- blanching.

Plasma osmolality

The number of osmoles per solvent.

Pleocytosis (pleocytic CSF)

An abnormal increase in the number of cells in the cerebrospinal fluid.

PN product

The product of platelet and neutrophil counts.

Polymerase chain reaction (PCR)

Polymerase chain reaction is a method of creating copies of specific fragments of DNA. The PCR rapidly amplifies a single DNA molecule into many DNA molecules so that further tests can be carried out.

Postictal

Refers to the altered state of consciousness that occurs following the cessation of a generalised seizure.

Procalcitonin

A precursor of the hormone calcitonin that is released into the bloodstream in response to infection or inflammation. Procalcitonin can be measured in blood samples and it is currently under development as a potential test for the detection of serious infections.

Protein C

Protein C is a major physiological anticoagulant. It is a vitamin K-dependent serine protease enzyme that is activated by thrombin into activated protein C (APC). The activated form (with protein S and phospholipid as a cofactor) degrades Factor Va and Factor VIIIa.

Protein S

Protein S is a vitamin K-dependent plasma glycoprotein synthesized in the endothelium. In the circulation, Protein S exists in two forms.

Pulse pressure

The pulse pressure is the difference in pressure between the highest blood pressure (systolic) and lowest blood pressure (diastolic) in one cardiac cycle. It represents the force the heart generates each time it beats.

Purpura

These are medium sized (2 mm or more diameter) purple spots. They may sometimes be slightly raised above the rest of the skin surface. They are non-blanching.

Raised intracranial pressure

When pressure exceeds 18 cm H20 with associated signs such as headache and vomiting. Signs suggesting raised intracranial pressure are:

  • a full or bulging fontanelle
  • relative bradycardia and hypertension
  • focal neurological signs
  • abnormal posture or posturing
  • unequal, dilated or poorly responsive pupils
  • papilloedema
  • abnormal ‘doll’s eye’ movements.

Rapid antigen testing

Rapid antigen testing looks for an antigen that is specific to the organism in question. These tests have problems with specificity (the proportion of negative test results which are correctly identified as being negative) and sensitivity (the proportion of positive test results which are correctly identified as being positive).

Real-time PCR

Real-time PCR is a laboratory technique that amplifies and measures the quantity of DNA produced.

Recombinant

Produced by genetic engineering.

Serogroup

One way of classifying a group of closely-related organisms based on a characteristic shared antigen. A serogroup may contain a number of serotypes.

Serotype

One way of classifying a group of closely-related organisms based on a characteristic shared antigen.

Shock

Condition in which the circulatory system fails such that the blood pressure is too low to provide adequate blood supply to the tissues.

Sign

A finding on physical examination of a patient that provides the clinician with an objective indication of a particular diagnosis or disorder (see also Symptom).

Subarachnoid space

The space between the two inner membranes of the meninges — the pia and arachnoid mater — which contains the cerebrospinal fluid. The meninges is a system of three membranes that surround the central nervous system: the inner pia mater, the arachnoid mater and the outer dura mater.

Symptom

A patient’s report of an abnormal feeling or sensation that provides the clinician with a subjective indication of a particular diagnosis or disorder (see also Sign).

Thrombin

Thrombin (activated Factor II [IIa]) is a coagulation protein that has many effects in the coagulation cascade. It is a serine protease that converts soluble fibrinogen into insoluble strands of fibrin, as well as catalysing many other coagulation-related reactions.

Thrombomodulin

Thrombomodulin is a cell surface-expressed glycoprotein, predominantly synthesised by vascular endothelial cells. It is a cofactor in the thrombin-induced activation of protein C in the anticoagulant pathway by forming a 1:1 stoichiometric complex with thrombin.

Tonic seizure

A seizure in which the limbs become stiff but do not jerk. A typical seizure usually lasts less than 20 seconds. Consciousness is usually preserved. If the person is standing when the seizure starts, he or she often will fall.

Vasopressin

A hormone that is produced in the neuronal cells of the hypothalamic nuclei and stored in the pituitary gland. It is used as a potent vasopressor in septic shock as it causes smooth muscle contraction.

Vasopressor

An agent that produces vasoconstriction and a rise in blood pressure (usually understood as increased arterial pressure).

Warm shock

Warm shock is a type of shock in children with sepsis characterised by high cardiac output and low peripheral vascular resistance.

Health economics terms

Cost–consequence analysis

A form of economic evaluation where the costs and consequences of two or more interventions are compared, and the consequences are reported separately from costs.

Cost-effectiveness analysis

A form of economic evaluation in which consequences of different interventions are measured using a single outcome, usually in ‘natural’ units (for example, life-years gained, deaths avoided, heart attacks avoided, cases detected). Alternative interventions are then compared in terms of cost per unit of effectiveness.

Cost-minimisation analysis

A form of economic evaluation that compares the costs of alternative interventions that have equal effects.

‘Cost of illness’ study

A study that measures the economic burden of a disease or diseases and estimates the maximum amount that could potentially be saved or gained if a disease was eradicated.

Cost–utility analysis

A form of cost-effectiveness analysis in which the units of effectiveness are quality adjusted life years (QALYs).

Decision(-analytic) model (and/or technique)

A model of how decisions are or should be made. This could be one of several models or techniques used to help people to make better decisions (for example, when considering the trade-off between costs, benefits and harms of diagnostic tests or interventions).

Decision tree

A method for helping people to make better decisions in situations of uncertainty. It illustrates the decision as a succession of possible actions and outcomes. It consists of the probabilities, costs and health consequences associated with each option. The overall effectiveness or cost effectiveness of different actions can then be compared.

Discounting

Costs and perhaps benefits incurred today have a higher value than costs and benefits occurring in the future. Discounting health benefits reflects individual preference for benefits to be experienced in the present rather than the future. Discounting costs reflects individual preference for costs to be experienced in the future rather than the present.

Dominate (in cost-effectiveness analysis)

A term used in health economics when a treatment option is both more clinically effective and less costly than an alternative option. This treatment is said to ‘dominate’ the less effective and more costly option.

Economic evaluation

Comparative analysis of alternative health strategies (interventions or programmes) in terms of both their costs and their consequences.

Equity

Fair distribution of resources or benefits.

Health-related quality of life

A combination of a person’s physical, mental and social wellbeing; not merely the absence of disease.

Incremental cost-effectiveness ratio (ICER)

The difference in the mean costs in the population of interest divided by the differences in the mean outcomes in the population of interest.

Markov modelling

A decision-analytic technique that characterises the prognosis of a cohort of patients by assigning them to a fixed number of health states and then models transitions among health states.

Model input

Information required for economic modelling. For clinical guidelines, this may include information about prognosis, adverse effects, quality of life, resource use or costs.

Net benefit estimate

An estimate of the amount of money remaining after all payments made are subtracted from all payments received. This is a source of information used in the economic evidence profile for a clinical guideline.

One-way sensitivity analysis (univariate analysis)

Each parameter is varied individually in order to isolate the consequences of each parameter on the results of the study.

Opportunity cost

The opportunity cost of investing in a healthcare intervention is the other healthcare programmes that are displaced by its introduction. This may be best measured by the health benefits that could have been achieved had the money been spent on the next best alternative healthcare intervention.

Probabilistic sensitivity analysis

Probability distributions are assigned to the uncertain parameters and are incorporated into evaluation models based on decision analytical techniques (for example Monte Carlo simulation).

Quality adjusted life year (QALY)

An index of survival that is adjusted to account for the patient’s quality of life during this time. QALYs have the advantage of incorporating changes in both quantity (longevity/mortality) and quality (morbidity, psychological, functional, social and other factors) of life. Used to measure benefits in cost–utility analysis.

Sensitivity analysis

A means of representing uncertainty in the results of economic evaluations.

Copyright © 2010, Royal College of Obstetricians and Gynaecologists.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK [www.cla.co.uk]. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

Cover of Bacterial Meningitis and Meningococcal Septicaemia
Bacterial Meningitis and Meningococcal Septicaemia: Management of Bacterial Meningitis and Meningococcal Septicaemia in Children and Young People Younger than 16 Years in Primary and Secondary Care.
NICE Clinical Guidelines, No. 102.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2010.

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