Delayed diagnosis is associated with complications following invasive meningococcal disease in Australian adolescents and young adults

Abstract Purpose This study described the presenting features, initial assessment, hospital care, and complications at discharge among Australian adolescents and young adults with Invasive meningococcal disease (IMD). Methods We conducted a retrospective study of IMD cases aged 15–25 years admitted between 2005 and 2018 in ten Australian hospitals. Results A total of 104 IMD cases were included; 95.2% were due to serogroup B, and the mean age was 19.3 years (SD 2.1). Initial assessment most commonly occurred in the emergency department following self-presentation/private transport (50.0%), followed by general practice (32.4%) and paramedic-led pre-hospital care (17.7%). The most common nonspecific presenting symptoms were headache (80.8%), vomiting or nausea (75.0%), and fever (72.1%), and category 3 was the most frequently assigned triage level (40.6%). Half of cases required ICU admission (50.0%), with a mean ICU stay of 2.8 days (SD 2.4). Compared with patients who self-presented to the emergency department, initial assessment by paramedics in the community was associated with higher odds of ICU admission (adjusted AOR 4.42, 95% CI 1.81 to 16.5). A delay of more than 1 day between symptom onset and first medical presentation was associated with higher odds of discharge with one or more complications (aOR 2.88, 95% CI 1.13 to 7.35). At discharge, 43.3% had at least one complication, most commonly neurological sequelae (55.6% of those with complications), and 2 cases (1.9%) died. Conclusion Delayed presentation was associated with a higher risk of IMD complications, highlighting the importance of early assessment and timely management to improve outcomes. Clinical trial registration Clinicaltrails.gov, NCT03798574, https://clinicaltrials.gov/study/NCT03798574 .