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Diagnostic Delays With Bacterial Meningitis-Reply FREE

Markku J. T. Kallio, MD; Terhi Kilpi, MD; Marja Anttila, MD; Heikki Peltola, MD
JAMA. 1995;273(8):622-622. doi:10.1001/jama.1995.03520320029035
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In Reply.  —In our series of 325 children with bacterial meningitis, we found that a prior visit to a physician and thus a possible diagnostic delay did not result in a worse clinical condition on admission to hospital, in a poorer recovery during hospitalization, or an increase in the risk of death or persistent sequelae.Dr Wenner emphasizes that the number of patents in our study is inadequate for any conclusions. He states that we should not have less than 187 000 patients to be able to say whether or not a difference of 1% exists between groups.However, our study is not a randomized controlled trial but an observational study. The use of significance testing in observational studies can be and has been questioned.1 Although we apply statistical tests and give P values, our conclusion is cautious, not straightforward "acceptance of the null hypothesis."While our 325 patients

REFERENCES

Bernman P, Crof P.  Interpreting the results of observational research: chance is not such a fine thing. BMJ . 1994;;309:727-730.
Herson VC, Todd JK.  Prediction of morbidity in Haemophilus influenzae meningitis. Pediatrics . 1977;;59:35-39.
Scheiffele DW, Daum RS, Syriopoulou VP, Averill DR, Smith AL.  Haemophilus influenzae bacteremia and meningitis in infant primates. J Lab Clin Med . 1980;;95: 450-462.
Radetsky M.  Duraton of symptoms and outcome in bacterial meningitis: an analysis of causation and the implications of a delay in diagnosis. Pediatr Infect Dis J . 1992;;11:694-698.
Kilpi T, Anttila M, Kallio MJT, Peltola H.  Severity of childhood bacterial meningitis and duration of illness before diagnosis. Lancet . 1991;;338:406-409.
Dodge PR, Davis H, Feigin RD, et al.  Prospective evaluation of hearing impairment as a sequela of acute bacterial meningitis. N Engl J Med . 1984;;311:869-874.

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Bernman P, Crof P.  Interpreting the results of observational research: chance is not such a fine thing. BMJ . 1994;;309:727-730.
Herson VC, Todd JK.  Prediction of morbidity in Haemophilus influenzae meningitis. Pediatrics . 1977;;59:35-39.
Scheiffele DW, Daum RS, Syriopoulou VP, Averill DR, Smith AL.  Haemophilus influenzae bacteremia and meningitis in infant primates. J Lab Clin Med . 1980;;95: 450-462.
Radetsky M.  Duraton of symptoms and outcome in bacterial meningitis: an analysis of causation and the implications of a delay in diagnosis. Pediatr Infect Dis J . 1992;;11:694-698.
Kilpi T, Anttila M, Kallio MJT, Peltola H.  Severity of childhood bacterial meningitis and duration of illness before diagnosis. Lancet . 1991;;338:406-409.
Dodge PR, Davis H, Feigin RD, et al.  Prospective evaluation of hearing impairment as a sequela of acute bacterial meningitis. N Engl J Med . 1984;;311:869-874.
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