• Nichlas Hovmand, ChristensenHelle CollatzHCDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.Emergency Medical Services, Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark., Lene Fogt Lundbo, Håkon Sandholdt, Gitte Kronborg, Perle Darsø, Jacob Anhøj, Stig Nikolaj Fasmer Blomberg, Asmus Thun Bisgaard, and Thomas Benfield.
• Center for Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark. nichlas.hovmand@regionh.dk.
• Bmc Fam Pract. 2021 Nov 30; 22 (1): 240.

BackgroundAn early appropriate response is the cornerstone of treatment for invasive meningococcal disease. Little evidence exists on how cases with invasive meningococcal disease present at first contact to emergency medical services.MethodsRetrospective observational study of cases presenting with invasive meningococcal disease from January 1st of 2016 to December 31st of 2020 in the Capital Region of Denmark with a catchment area population of 1,800,000. A single medical emergency center provides services to the region. Data was collected from emergency medical services' call audio files, data from the call receiver registrations, registrations from ambulance personal and electronic health record data from the hospitalization.ResultsOf 1527 cases suspected of meningitis, 38 had invasive meningococcal disease and had been in contact with the emergency service. Most contacts were to the medical helpline rather than the emergency call center at initial contact to emergency medical services. All were hospitalized within 12 h. At initial contact, fever was present in 28 (74%) of 38 cases, while specific symptoms such as headache (n=12 (32%)), a rash or petechiae (n=9 (23%)) and stiffness of the neck (n=4 (11%)) varied and were infrequent. Cases younger than 18 years of age were more often male and more often presented with fever and rash/petechiae. Only 4 (11%) received prehospital antibiotic treatment.ConclusionsCases with invasive meningococcal disease presented with fever and unspecific symptoms. Although few were acutely ill at their initial contact, all were admitted within 12 h. We suggest that all feverish cases should be systematically asked about specific symptoms and should be wary of symptom progression to optimize the early management if cases with invasive meningococcal disease.© 2021. The Author(s).

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