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New symptoms to identify meningitis before classic rash

Key signs include cold extremities, leg pain and abnormal skin colour

UK researchers have challenged medical orthodoxy after identifying a set of symptoms which can identify meningitis before the appearance of the classic rash.

The GP researchers predicted looking for early signs of sepsis in all children with fever would increase the cases spotted in initial consultations by 50 per cent.

Three early symptoms of sepsis ­ leg pain, cold hands and feet, and abnormal skin colour ­ occurred within the first 12 hours of illness, the study found.

Some 72 per cent of children had at least one of these symptoms at their first GP consultation, a median of eight hours into the disease course. But the classic symptoms of rash, neck pain and photophobia did not appear until 13 to 15 hours.

The study, published online by The Lancet this week, found only 51 per cent of 448 children under 16 who were hospitalised for meningococcal disease were referred after the first consultation in primary care.

The average time of admission of the children in the study was 19 hours and most children were close to death by 24 hours.

Study leader Dr Matthew Thompson, clinical lecturer in general practice at the University of Oxford and a GP in the city, warned GPs were 'over-reliant' on classic symptoms and could be falsely reassured by their absence.

He said: 'The classic symptoms we look for all occurred quite late in the pre-hospital phase and that's probably why about half of cases are missed by the GP when they first attend. These new sepsis symptoms should help to pick things up in the early stages.

'It does make the case that the GP should assess and examine the child, which is hard to do over the telephone.'

The study is the first to look at the time-course of symptoms before admission and used information from GP records and parent questionnaires.

Dr Karen Roberts, medicolegal adviser at the Medical Defence Union, said anything helping GPs to recognise meninigitis earlier would be 'very useful'.

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