Reference 2018-261

REF:          2018-261 

Subject:      CRP rises in Neonatal Meningitis 

 

 

Request:

Thank you for your response to my recent Freedom of Information request dated 31st March 2018, reference 2019-195. Thank you for your timely response.

In that request, in question 5, you responded saying you had 13 episodes of neonates which also had meningitis between 1/10/2015 and 31/3/18. These were the episodes which were coded both Z38.* and G00/G01/G02/G03.

I would like to make a focussed follow-up request on these neonates who had meningitis. This will be my final FOIA request.

 

Follow-up Request:

For the group of neonates with meningitis identified in Q5 of my previous request, each neonate will have a maximum C-Reactive Protein (CRP) rise seen during their meningitis infection. Please provide

1) the average (mean) CRP rise

2) the lowest CRP rise seen

3) a banded breakdown of the CRP rises seen, grouping the results to the nearest 10 (ie stating the number of patients in the range 0-9.9mg/L; 10-19.9mg/L; 20-29.9mg/L etc)

 

Notes to help complete request:

a) The C-reactive protein (‘CRP’) is a blood test that will be carried out on all neonates who are suspected of having an infection. It is usually measured in mg/L (or occasionally mg/dL).

b) The levels of CRP rise when there is an infection. The single highest level they reach is the ‘CRP rise’ referred to in my request.

c) Meningitis is diagnosed by having a lumbar puncture to collect cerebrospinal fluid (‘CSF’) from the lower back. This is fluid that surrounds the brain and spinal cord. To be diagnosed with meningitis this CSF will either have a high number of white cells (usually > 20/mm3), grow bacteria (in a culture), or test positive for bacterial or viral DNA/RNA.

 

Therefore to complete the request, you will have to:

d) For each of the neonates with meningitis identified in Q5 of my previous request you will have to identify the date of the positive ‘CSF’ sample was taken from the results on your system. The definition of positive is included in c) above. If a positive CSF cannot be found, do not include the patient.

e) You will have to look at the blood results of this neonate for the 4 days before and 4 days after this CSF sample was taken, and record the highest CRP value from any blood tests taken in that specific time period. This highest value is the ‘CRP rise’ for that patient. You do not need to look at any CRP levels that might have been taken outside this 8 day period.

f) You should have one value of ‘CRP rise’ for each patient. If there is more than one positive CSF sample per patient, please only use the first positive CSF sample.

g) Please provide me with the average of all these values for part 1), the lowest for part 2) and then a banded breakdown to the nearest 10 for part 3). For example if the CRP rises from each patient were 40, 40, 60, 80, 100 mg/L, then the average would be 64mg/L, the lowest 40mg/L, and the bandings would be 40-49.9: 2; 60-69.9: 1; 80-89.8: 1; 100-109.9: 1.

 

I realise this request may be resource intensive. I would estimate that it would take a maximum of 5-10 minutes per patient, as all the information is held electronically but it does require manual searching of electronic blood results for the data for a just over one-week period around the positive CSF.

 

 

Response:

Average CRP rise  (mg/l) 66.10
Lowest CRP rise  (mg/l) 1.9

Bands for  CRP rise (mg/l)

No. of patients

0-9.9 3
10-19.9 1
20-29.9 1
30-39.9 1
40-49.9 1
50-59.9 0
60-69.9 1
70-79.9 0
80-89.9 1
90-99.9 1
100-109.9 0
110-119.9 1
120-129.9 0
130-139.9 0
140-149.9 0
150-159.9 0
160-169.9 0
170-179.9 0
180-189.9 0
190-199.9 1
One patient has been excluded as didn’t meet the criteria.