[Assessment of clinical practice in patients with infectious meningitis]. / Evaluación de la práctica clínica en pacientes diagnosticados de meningitis infecciosa.

OBJECTIVES: Medical practice assessments for a specific patient population can be useful for improving health care quality and decreasing the variations in clinical practice. Our aim was to assess compliance with clinical practice guidelines established for patients with meningitis using previously formulated indicators. METHODS: The indicators of quality were based on clinical practice guidelines and selected through consensus meetings. A data protocol was designed and applied retrospectively to the medical records of all patients with a diagnosis of meningitis between 1987 and 2004 in a 280-bed general hospital. RESULTS: A total of 99 episodes were included. Information on pre-treatment was recorded in 94%, duration of symptoms in 65%, funduscopic examination in 21%, and cerebrospinal fluid (CSF) pressure in 5% of patients. Biochemical and microbiological CSF study was adequate (93%-99%), but blood culture (73%) was not. Cranial CT scan was adequate in 52% of patients, since in many cases it was performed without an indication for this study. Treatment was given according to the local protocol in 53.6% of patients with suspected bacterial meningitis and 79.5% of those with suspected viral meningitis. Three patients died due to meningitis. CONCLUSIONS: The use of funduscopic examination was poor, whereas the use of cranial CT scanning was excessive. Treatment of bacterial meningitis adhered to the established local antibiotic protocol in half the patients. This type of auditing is useful for determining compliance with guidelines and designing strategies to improve health care quality.

[Hepatitis as unique manifestation of Q fever: clinical and epidemiologic characteristics in 109 patients]. / Hepatitis aislada como forma de presentación de la fiebre Q: características clínicas y epidemiológicas en 109 pacientes.

INTRODUCTION: To describe the clinical and epidemiologic characteristics of hepatic involvement in a cohort of 109 patients with Q fever. RESULTS: Involvement of the liver alone was documented in 55% of cases. In 96% it was manifested as a febrile process without focal symptoms and hepatic cytolysis. There were no differences in epidemiologic characteristics between patients with hepatitis and those and without. CONCLUSION: Q fever should be included in the differential diagnosis of community-acquired febrile syndromes.