Volume 24, Issue 2, Pages 61 – 108 (2025)

Trends in the diagnosis and management of infective meningitis at a tertiary centre over 10 years: a retrospective cohort study providing further evidence for culture-independent diagnostics

Original Articles, Volume 24, Issue 2, Pages 61 – 108 (2025)

Objective: This retrospective study analysed clinical characteristics, diagnosis, and management of infective meningitis patients at a UK-centre, aiming to identify emerging trends in the patient pathway.
Methods: A ten-year review of meningitis patients at a UK tertiary centre was conducted. Inclusion criteria encompassed signs/symptoms of meningitis with CSF WCC ≥4 cells/mm3 or causative pathogen identification.
Results: The study included 298 patients with infective meningitis were included (184 viral, 87 bacterial, 22 tuberculosis, 5 fungal). Key findings indicated underutilisation of culture-independent investigations, delayed administration of antibiotics, and lumbar puncture. Viral meningitis cases with a positively identified causative virus had shorter hospital stays.
Conclusion: Culture-independent investigations are under-utilised in meningitis diagnosis. Patients experience delays in essential interventions. Future advancements in rapid, point-of-care genomic sequencing could enhance diagnostic accuracy and speed.

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Development and Validation of a Comorbidity Index to Predict In-hospital Mortality Risk for Stevens-Johnson Syndrome

Original Articles, Volume 24, Issue 2, Pages 61 – 108 (2025)

Background: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of high-mortality severe drug reactions. This study aimed to develop an in-hospital mortality risk calculator for SJS based on comorbidities for early risk prediction.
Methods: SJS/TEN patients were identified in National/Nationwide Inpatient Sample between Q4 2015-2020. Weight for each comorbidity was determined from a multivariable logistic regression to develop SJS Index.
Results: SJS Index had good discrimination power (c-statistic=0.704) and was well-calibrated (Brier score=0.049). SJS index had significantly better discriminative power than Elixhauser Comorbidity Index (p-value=0.001). SJS Index has good applicability in SJS-TEN and TEN. After adjusting for demographics, SJS Index had improved performance in all groups.
Conclusions: SJS Index effectively discriminates and predicts in-hospital mortality in SJS/TEN.

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Frontal lobe epilepsy- why it matters in the emergency department

Original Articles, Volume 24, Issue 2, Pages 61 – 108 (2025)

Frontal lobe epilepsy is an episodic neurological disorder characterised by recurrent seizures arising from one or both frontal lobes. Seizures may appear atypical and are easily misdiagnosed in the emergency department as nonepileptic attacks (psychological episodes) or parasomnias (sleep disorders). Given the multiple connections and functions of the frontal lobes, Frontal lobe epilepsy presentations are highly variable, including motor, psychic, behavioral or cognitive changes, with a wide differential diagnosis. Prompt diagnosis in the busy emergency department may be difficult, because of complex, often multiple but brief episodes, and sometimes bizarre manifestations; frequent nocturnal presentation, and a wide range of aetiologies. This narrative review summarises clinical and investigation features that help clinicians to reach an accurate and prompt diagnosis.

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A National Survey of Geriatric Emergency Health Care: Insights into Current Practice

Original Articles, Volume 24, Issue 2, Pages 61 – 108 (2025)

Background: Emergency departments (EDs) are increasingly managing elderly patients who present unique clinical challenges. This study explores the current management practices for patients aged 75 years and older in Belgian EDs.
Methods: An electronic survey was sent to 105 heads of Belgian EDs. The Collected data underwent descriptive analysis.
Results: Geriatric protocols, adapted equipment, availability of geriatricians, and paramedical staff improve the quality of care for older patients in the EDs. However, the limited use of geriatric scores, prolonged stays in the ED, and lack of hospital beds are frequent problems that negatively impact quality of care.
Conclusion: Given the variable level of care provided to the elderly in the EDs, care protocols should be standardized and improved at the national scale.

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Editorial – The evolving research landscape in the United Kingdom

Editorials, Volume 24, Issue 2, Pages 61 – 108 (2025)

Over the current and subsequent few financial years, a set of significant changes will be implemented affecting the research landscape in the United Kingdom. On the 22nd of September 2025 NHS England released the paper “Increasing research activity in the NHS”1. This paper highlights the clear ambitions of decreasing trial set up times, from the current 250 to under 150 days, while doubling commercial interventional trial participants by 2026 and again by 2029 in the UK. The paper also reveals the UK’s aspiration to become a more attractive Country for international research and commercial investments from the biotechnology industry sector. The plan builds on the Government’s “Life Science Sector Plan”2, published in July 2025, which followed “Fit for the Future: 10 Year Health Plan for England”3. The government has consistently highlighted a commitment for the NHS to support the life sciences industry in the UK. Importantly, research performance will be monitored at both aggregate and individual site level. Furthermore, each NHS organisation’s research budget will be allocated based on historical performance, number of studies and recruitment activity (with weighting based on the type of study), and new performance, including study set up times, efficiency of delivery and commercial research activity expansion.

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The Evolution of Acute Medicine Specialist Skills

Original Articles, Volume 24, Issue 2, Pages 61 – 108 (2025)

Background: Specialist skills are central to the AIM curriculum, supporting both service delivery and portfolio careers.
Methods: We surveyed UK Acute Medicine consultants and registrars via the Society for Acute Medicine to assess specialist skills selected, perceived value in obtaining consultant roles, and job-planned time.
Results: 146 responses (64 registrars, 82 consultants) were received across all UK regions. Among registrars, Intensive Care Medicine (19%) and echocardiography (14%) were most common. Medical Education, while previously dominant among consultants, has declined. Skills such as Neurology and Infectious Diseases were less frequently chosen but associated with greater job-planned time and perceived value.
Conclusions: Specialist skill preferences are changing, influenced by training pathways and consultant job structure. With increasing rates of burnout and moral injury, as well as changes to the AIM curriculum, it is vital that we monitor trends in their selection going forward.

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To LP or not to LP? A service evaluation investigating the prevalence of subarachnoid haemorrhage in patients undergoing a lumbar puncture in the acute medical setting

Original Articles, Volume 24, Issue 2, Pages 61 – 108 (2025)

Subarachnoid haemorrhage (SAH) is a potentially life-threatening cause of acute severe headache. This service evaluation aimed to investigate the prevalence of SAH in patients referred to acute medicine with acute severe headache who underwent a lumbar puncture (LP) at a tertiary teaching hospital, over a four-year period. Of the 677 samples analysed for CSF bilirubin, 619 were negative (91.5%), 48 indeterminate (7%), and 10 classified as positive (1.5%). Only one patient (0.1%) was diagnosed with an aneurysmal SAH and underwent intervention. Therefore, the diagnostic yield of an LP to exclude SAH in this setting is extremely low. This service evaluation challenges the dogma that LP is necessary in all patients with acute severe headache.

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