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MANAGEMENT OF SUSPECTED ENCEPHALITIS IN A UK TEACHING HOSPITAL
  1. Sophie Binks,
  2. Rebecca Cooper,
  3. Ruth Wood,
  4. Llewelyn Martin
  1. Brighton and Sussex University Hospitals NHS Trust

Abstract

Introduction Though infective encephalitis is relatively rare, prompt treatment significantly improves outcomes. In 2012, new national guidelines for management of suspected viral encephalitis were launched. We audited cases at Brighton and Sussex University Hospitals NHS Trust.

Method Cases were identified retrospectively via medical coding and pharmacy records of patients to whom IV aciclovir was dispensed, between April 1 2012–June 30 2013. 42 cases were audited against the guidelines.

Results In 10 cases (24%), the final diagnosis was encephalitis but in only one was an organism confirmed (varicella). Time to suspecting encephalitis ranged from on admission to 27 days. No LP was performed in seven cases, and achieved in <6 hours in four (10%). Paired plasma glucose was not performed in 51% of LPs. Almost all patients (95%) started aciclovir, and 76% received MRI brain at a median of 3 days. HIV testing was performed in 60%. 26% were admitted to ITU and 24% died.

Conclusions Encephalitis is difficult to confirm and eventual differential of suspected cases is wide. The rate of ITU admission and death demonstrates the vulnerabilities of this cohort. While most patients received LP, aciclovir and MRI, there remains room for improvement in timing and completeness of investigations.

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