An intervention to improve diagnosis and early management

Based on our assessment of current practice, we will develop a sustainable multi-component intervention in collaboration with service users and providers, tailored to each hospital’s needs. The service improvement intervention will be designed to tackle challenges and barriers to optimal care, and will comprise a number of components, including a staged approach to improved diagnostics, clinical and laboratory training, access to equipment and consumables, clinical algorithms, and logistical improvements.

One challenge is the underuse of lumbar puncture procedures to obtain cerebrospinal fluid, which is critical for confirming and identifying causes of brain infection. In the UK, we have shown that the introduction of a simple lumbar puncture pack, containing appropriate equipment and guidance, greatly improved the uptake and performance of this investigation, e.g. increasing the percentage of patients with a PCR diagnosis from 17% to 50% [13]. We will pilot its use in resource-limited settings within the intervention.



13. Michael BD, Powell G, Curtis S, et al. Improving the diagnosis of central nervous system infections in adults through introduction of a simple lumbar puncture pack. Emerg Med J 2013; 30: 402-5.