To describe the presentation of meningococcal disease in primary care ; to explore how general practitioners process clinical and contextual information in children with meningococcal disease ; and to describe how this information affects management.
Qualitative analysis of semistructured interviews.
General practices in South Glamorgan.
26 general practitioners who between January 1994 and December 1996 admitted 31 children (under 16 years of age) in whom meningococcal disease was diagnosed.
Categories of clinical rules and techniques used by general practitioners in processing each case.
22 children had rashes ; in 16 of them the rashes were non-blanching.
When present, a haemorrhagic rash was the most important factor in the doctor's decision to admit a child. 22 children had clinical features not normally expected in children with acute self limiting illnesses-for example, lethargy, poor eye contact, altered mental states, pollor with a high temperature, and an abnormal cry.
Contextual information, such as knowledge of parents'consultation patterns and their normal degree of anxiety, played an important part in the management decisions in 15 cases.
Use of penicillin was associated with the certainty of diagnosis and the presence and type of haemorrhagic rash.
The key clinical feature of meningococcal disease-a haemorrhagic rash-was present in only half of the study children. (...)
Mots-clés Pascal : Exanthème, Méningococcie, Bactériose, Infection, Diagnostic, Soin santé primaire, Médecin généraliste, Méthodologie, Relation, Symptomatologie, Evaluation performance, Enfant, Homme, Peau pathologie
Mots-clés Pascal anglais : Exanthema, Meningococcal disease, Bacteriosis, Infection, Diagnosis, Primary health care, General practitioner, Methodology, Relation, Symptomatology, Performance evaluation, Child, Human, Skin disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0104995
Code Inist : 002B05B02C. Création : 22/06/1998.