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Tut09 Case 4 tutorial - Headache _ Fever 2

B Case 4 tutorial - Headache & Fever 2

Tut8 Case B Case 4 Tutorial - Headache _ Fever 1 PRep for this/ IDl form last: READ articles 1 and For an update on antimicrobial resistance and the latest New Zealand Guidelines on pre-hospital and hospital- based empiric treatment of patients suspected to have meningitis, just REFER to the sources listed under number 2 to help you answer the questions in Task 6 pre-populate the questions in this task, ready to discuss next week

  1. Riddell T, & Bullen C. [2003] Pre-hospital antibiotic treatment of meningococcal disease: scope for improvement. NZMJ;116:118
  2. For recent guidelines go to the NZ Ministry of Health information for health professionals Meningococcal Disease website at: https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/diseases-and-conditions/meningococcal and BpacNZ https://bpac.org.nz/antibiotics/guide.aspx
  3. Croskerry, P 2003 The Importance of Cognitive Errors in Diagnosis and Strategies to Minimise Them. Academic Medicine 78:8. Articles 1 and 3 can be found in the eReserve folder in the Integrated Case Resource area of Moodle.

SPECIFIC TASK RELATING TO THE CROSKERRY PAPER Globally, there were more than 496 million confirmed cases and over 6 million reported deaths from COVID- 19 on April 10, 2022 [WHO, April 2022]. History tells us that singularly focusing on a new pandemic can lead to the resurgence of other important infectious diseases [e.g. measles and malaria, in the context of Ebola.

Despite the development of vaccines meaning there has been some significant success in controlling meningococcal disease, there was still an estimated 2.5 million reported cases of meningitis in 2019 alone. This includes 1.6 million cases of bacterial meningitis, which resulted in 240,00 deaths. [WHO 2025]. One in six of those people who contract bacterial meningitis will die, and around 20% will develop long term complications.

This Case looks at bacterial meningitis, for which global progress in the reduction of both mortality and morbidity has substantially lagged behind that made with other vaccine-preventable diseases. The WHO are significantly concerned – enough to recently launch the WHO first-ever guidelines on meningitis diagnosis, treatment and cate. [WHO 2025]

There is an element of uncertainty surrounding the clinical diagnosis of meningitis. Meningitis in its early stages can look like flu, but then rapidly develop into a life-threatening condition, especially in youngerpeople.

It is a diagnosis that must not be missed.

The Croskerry paper looks at doctors’ cognitive biases that lead to Cognitive Dispositions to Respond (CDR) and subsequent errors in diagnostic decision-making ‘at the front line, when resources are in short supply, time constraints apply and when shortcuts are being sought’

Diagnostic errors are relatively commonplace, represent a threat to patient safety, and are associated with proportionately higher morbidity than that seen with other types of medical errors. If Frank did not receive a correct and timely diagnosis, he could die. YOUR TASK Choose three [3] CDRs from the list provided in the Croskerry paper and for each:

  1. Explain the basis of the CDR
  2. Write a brief [one paragraph] scenario to demonstrate how your chosen CDR could influence Dr Pierce’s evaluation of Frank’s initial presentation at his general practice.
  3. Come prepared to share at least one of your CDR scenarios next tutorial. References
    1. Croskerry, P (2003) The Importance of Cognitive Errors in Diagnosis and Strategies to Minimise Them. Academic Medicine 78:8 World Health Organisation [WHO] Coronavirus [COVD-19] Dashboard at https://covid19.who.int/

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