A complete dataset audit of herpes simplex encephalitis at the royal free foundation trust (2018–2023)

<h3>Introduction</h3> Herpes Simplex Virus (HSV) is the most common cause of infective encephalitis and is associated with significant morbidity and mortality. The 2012 British Society of Infection &amp; Association of British Neurologists (BSI) National Guidelines provide an auditable standard for the investigation and management of patients with suspected or confirmed encephalitis. <h3>Methods</h3> A complete dataset of all cases of HSV encephalitis from a large North London Hospital Trust was obtained by acquiring all positive CSF PCR samples from the reference laboratory over a 5-year period. A retrospective audit was undertaken of all positive cases against BSI guidelines. <h3>Results</h3> 20 cases were identified. There was marked heterogeneity in the investigation and management of HSV encephalitis. Whilst certain standards were consistently met (e.g. all cases received prompt CT imaging with mean door-to-CT time of 6:28 hours), there were significant delays in acquiring lumbar puncture (mean 33 hours), MRI imaging (mean 145 hours), receiving acyclovir (mean 27:42 hours), and a second LP was infrequently obtained prior to ceasing acyclovir. <h3>Discussion</h3> Obtaining timely interventions remains a challenge for patients with HSV encephalitis, with clinical practise frequently deviating from guidelines. Educational interventions targeted at emergency departments are being initiated in an attempt to improve care standards.