<p>A girl in my school died from bacterial meningitis when I was a teenager. I still feel very sad when I think about that girl </p>
<p>Viral meningitis can now easily be ruled out with the aid of PCR in less than 3 hr:</p>
<p>May be the hospital was not equipped to do this </p>
<p>^
I only wish clinical medicne could be that simple - I would be going home with less epigastric pain and worries of whether I made the right diagnostic decision with my patients today. And this is after 15yrs of doing this. Not all atypical meningitis is enterovirus in etiology, and not all bacterial meningitis is meningococcal. The art of being a clinician is knowing when to trust your labs vs your physical exam, and sometimes both your labs and the exam say one thing, but inside, you feel it's something else...something that you're missing. And, despite all of this, sometimes you're wrong, and you pray that it won't have a significant morbidity to the final outcome.</p>
<p>It's not easy, and that's why a lot of very good doctors are leaving the profession. The pressures of being "right" with the diagnosis practically 100% of the time burns you out and makes you get "old" very quickly.</p>
<p>^Amen to that, brother.</p>
<p>God, this is horrible! At first, I was really indignant on behalf of the parents of that poor girl. But, after reading all the posts by the doctors on the forum, I now feel grief for the poor doctors on the case. It's just such a tragedy all around. You MDs have my utmost respect. I'd hate to be in your shoes when faced with these kinds of decisions---and I understand that you face them on a regular basis. Too bad medicine is still such an inexact science. Too bad doctors aren't really all-seeing, all-knowing gods afterall.:(</p>
<p>I do feel the same way Diagnostics have a long way to go, and therapeutics have an even longer one. I used to watch a show on TV and thought, god, that ER room looked unreal until I had to drive my husband to our local ER. Drunk guys with gunshot wounds, crying puking babies, senile ladies who overdosed on some of their multiple meds! I would not be able to function in this environment, and you guys have to make life or death decisions in such conditions. Thank you for being there for us.</p>
<p>Daily Pennsylvanian article on the same topic.</p>
<p>As the OP, after reading all of the posts by physicians who know a lot more about this than me or the reporters, I now see that this is not necessarily a clear case of incompetence on the part of the hospital. I guess we can all agree that this is a terrible tragedy for all involved.</p>
<p>The article does state that she was released "after she opted not to stay overnight" and that her "spnal tap was negative." Twice it reports she elected not to stay overnight, which would have been for observation of her clinical status and to watch for worsening of symptoms, and supportive treatment such as IV fluids, meds for nausea, etc. She did not live on campus, either. So she did not have a network of dormmates, RA's etc to see her deteriorate or to encourage her to get back to the hospital. </p>
<p>Until we were to actually have her medical records, it appears that this is a tragic bacterial meningitis death, and that is all that we can say.</p>
<p>Having been through this experience with H, who presented with viral type symptoms. If a flag goes off that "It could be" bacterial, but many cultures take time to grow, why would they not err on the side of caution?? Is it really worth playing the odds?</p>
<p>My H had fever and stiffness, ( and a crazy wife) The ER doctor called an infectious disease doctor who put him on massive I.V. antibiotics until cultures all came back, Had they not he would have been dead in 24 hours as he had bacterial strep! </p>
<p>So my question is if there is a question, why not give the antibiotics??</p>
<p>Also extremely important to discuss with your children that they should STAY in Hospital if it offered and that they sign all those notification and waivers for their parents to speak to doctors at any time.</p>
<p>So Very sad.</p>
<p>
[quote]
So my question is if there is a question, why not give the antibiotics??
[/quote]
Because massive doses of antibiotics are not without their own risks. Read some of the posts above by physicians about prophylactic antibiotics.</p>
<p>"Give this ER doctor a break"</p>
<p>Sorry, Jack. Who gave Ms. Ryan a break?</p>
<p>Ms. Ryan's blood is on the hands of those who did not take care of this young lady appropriately.</p>
<p>With her symptoms, and the possible fatal outcome in the event that it was indeed bacterial menningitis, she should have never been released. She should have received IV antibiotics as a preventative and possibly lifesaving measure and she should have been TOLD that she MUST stay for observation as tests do not always come back positive right away. I believe that those in charge did not communicate to her that she could still have bacterial menningitis even though the current tests did not indicate that she did. DO YOU REALLY THINK THAT GIVEN THE INFORMATION THAT SHE COULD DIE WITHOUT BEING OBSERVED/RECEIVING IV ANTIBIOTICS THAT SHE WOULD OPT TO LEAVE THE HOSPITAL?????I highly doubt it.</p>
<p>sonssecty- You don't have any better information than anyone else does. This is an excellent hospital with excellent staff. Yes, mistakes do happen, but there is no evidence that one occurred here- just speculation and a plaintiff's lawyer looking to make some bucks. I have defended many tragic lawsuits where a family in pain was looking for a reason for their loss. I understand this, but it doesn't make the hospital or doctor guilty. I suspect Ms. Ryan had proper care but died anyway.</p>
<p>Although we don't have the facts, the information we do have doesn't make sense.<br>
If the spinal tap takes 24-48 hours to culture, how could it have come back with a negative reading the same day she was admitted? I think it's this confusing information that has people thinking a mistake has been made. But maybe the reporting is wrong - we just don't know.</p>
<p>This is such a sad and scary story. But it is anything but clear cut.
No way that we here can know all that happened unless we see the chart notes and lab results.
Bacterial meningitis can kill even WITH proper treatment. Massive antibiotics just 'in case' can result in significant morbidity or mortality. Medicine is just not a perfect science.</p>
<p>ASAP- While cultures DO take 24-72 hours, there are same day results to help substantiate a diagnosis of bacterial meningitis: bacterial antigen screens, gram stain, glucose, protein, cell count, etc.</p>
<p>Still, it's usually not an easy call. My heart goes out to the family.</p>
<p>This is certainly a case where we don't have all the information, and it's stupid to judge the situation as if we know everything. There doesn't, at least, seem to be any evidence of gross negligence. Someone made a judgment. Obviously it was wrong. Maybe the doctor's decisions to let her leave and to not begin treatment were in error, or maybe they were legitimate given the details of her case. In any event, we don't know. </p>
<p>I hate the fact that doctors' mistakes matter so much more than everyone else's mistakes. It sucks for everybody involved that a human needs to make these calls. Anyway, I guess it's just part of the territory.</p>
<p>(Doctors thought I had bacterial meningitis when I landed in the hospital as a neonate with a fever near 106. A couple of specialists had to be called in, and the first thing they did, after kicking my parents out of the room, was run an LP. Anyway, it took several days to diagnose me with something that wasn't meningitis. I don't believe I was put on antibiotics until an infection was confirmed.)</p>
<p>"she should have been TOLD that she MUST stay for observation as tests do not always come back positive right away." </p>
<p>You cannot force a patient to stay in the hospital against their will unless they are deemed unable to understand the risks and benefits of the treatment. You can even be acutely psychotic and leave a hopsital against medical advice. This is called leaving "AMA" or against medical advice.</p>
<p>"I believe that those in charge did not communicate to her that she could still have bacterial menningitis even though the current tests did not indicate that she did."</p>
<p>To Shrinkrap: I didn't say "force" the patient to stay. I'm saying that the seriousness of the prognosis was OBVIOUSLY NOT COMMUNICATED TO THE PATIENT and that had it been communicated to her that she could DIE if it turned out that she actually DID have menningitis, she would have stayed in the hospital...as a matter of fact, I believe she would have insisted on not leaving!</p>
<p>MomofWildChild: I could care less about the stupid lawsuit. Oh, by the way, I am quite familiar with HUP. As a matter of fact I was a patient there in the past and was treated properly. I have also directed my son to go to that particular hospital should the need arise while he is at college. I am not saying anything bad about the hospital, in general.</p>
<p>In case you can't tell, I am extremely upset by what happened to this girl and believe that it probably could have and should have been prevented.</p>
<p>I have a feeling that if this had happened to YOUR child, you'd be all over the hospital/doctor(s) like flies.....</p>
<p>Um if she actually had meningococcal meningitis at the time she was in the ER she would have been dead the following morning. She went back 2 days later. What likely happened was she indeed had a viral infection. The viral infection suppressed her immune system allowing the neisseria colonized in her throat to spread to her blood and CSF.</p>