CHAPTER 49 CT BEFORE LUMBAR PUNCTURE IN MENINGITIS

Computed Tomography of the Head Before Lumbar Puncture in Adults With Suspected Meningitis

Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. N Engl J Med. 2001;345(24):1727–1733

BACKGROUND

At the time of this study, CT scan was routinely preformed in patients suspected of having bacterial meningitis prior to performing lumbar puncture (LP). It was thought that this was critical to identifying occult intracranial abnormalities that could put the patient at risk for brain herniation caused by the LP. However, this practice leads to delays in antibiotics and exposes patients to potentially unnecessary cost and radiation. This study sought to determine if there was a subgroup of patients who did not require CT before LP.

OBJECTIVES

To determine if the absence of certain clinical features can identify adults with suspected meningitis who are unlikely to have abnormalities on their CT head.

METHODS

Prospective observational study at a single academic ED in the United States between 1995 and 1999.

Patients

301 patients, >16 years old, with suspected meningitis. Of these, 235 patients underwent CT of the head and 289 underwent LP.

Interventions Evaluated

Structured data collection of clinical features prior to CT of the head.

Outcomes

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