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Emergency Radiology

Erschienen in:

02.05.2024 | Original Article

Comparison of international guidelines for CT prior to lumbar puncture in patients with suspected meningitis

verfasst von: Fergus O’ Herlihy, Philip J Dempsey, Dora Gorman, Eavan G Muldoon, Brian Gibney

Erschienen in: Emergency Radiology | Ausgabe 3/2024

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Abstract

Purpose

To compare the performance of multiple international guidelines in selecting patients for head CT prior to lumbar puncture (LP) in suspected meningitis, focusing on identification of potential contraindications to immediate LP.

Methods

Retrospective study of 196 patients with suspected meningitis presenting to an emergency department between March 2013 and March 2023 and undergoing head CT prior to LP. UK Joint Specialist Society Guidelines (UK), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Infectious Diseases Society of America (IDSA) guidelines were evaluated by cross-referencing imaging criteria with clinical characteristics present at time of presentation. Sensitivity of each guideline for recommending neuroimaging in cases with brain shift on CT was evaluated, along with the number of normal studies and incidental or spurious findings.

Results

2/196 (1%) patients had abnormal CTs with evidence of brain shift, while 14/196 (7%) had other abnormalities on CT without brain shift. UK, ESCMID and IDSA guidelines recommended imaging in 10%, 14% and 33% of cases respectively. All three guidelines recommended imaging pre-LP in 2/2 (100%) cases with brain shift. IDSA guidelines recommended more CT studies with normal findings (59 vs 16 and 24 for UK and ESCMID guidelines respectively) and CT abnormalities without brain shift (4 vs 1 and 2 respectively) than the other guidelines.

Conclusion

UK, ESCMID and IDSA guidelines are all effective at identifying the small cohort of patients who benefit from a head CT prior to LP. Following the more selective UK/ESCMID guidelines limits the number of normal studies and incidental or spurious CT findings.

Ellis J, Harvey D, Defres S et al (2022) Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR). https://doi.org/10.1136/bmjopen-2022-062698. BMJ Open 12:

Salazar L, Hasbun R (2017) Cranial imaging before lumbar puncture in adults with community-acquired meningitis: clinical utility and adherence to the Infectious Diseases Society of America Guidelines. Clin Infect Dis 64:1657–1662. https://doi.org/10.1093/cid/cix240CrossRefPubMedPubMedCentral

Imtiaz A, Toomath R (2019) Computed tomography head scans prior to lumbar punctures in suspected meningitis. Intern Med J 49:55–58. https://doi.org/10.1111/imj.13997CrossRefPubMed

Van Crevel H, Hijdra A, De Gans J (2002) Lumbar puncture and the risk of herniation. when should we first perform CT?

Joffe AR (2007) Lumbar puncture and brain herniation in acute bacterial meningitis: a review. J Intensive Care Med 22:194–207CrossRefPubMed

Michael B, Menezes BF, Cunniffe J et al (2010) Effect of delayed lumbar punctures on the diagnosis of acute bacterial meningitis in adults. Emerg Med J 27:433–438. https://doi.org/10.1136/emj.2009.075598CrossRefPubMed

Bodilsen J, Brandt CT, Sharew A et al (2018) Early versus late diagnosis in community-acquired bacterial meningitis: a retrospective cohort study. Clin Microbiol Infect 24:166–170. https://doi.org/10.1016/j.cmi.2017.06.021CrossRefPubMed

Gopal AK, Whitehouse JD, Simel DL, Corey, G Ralph (1999) Cranial Computed Tomography Before Lumbar Puncture A Prospective Clinical Evaluation

Schuh S, Lindner G, Exadaktylos AK et al (2013) Determinants of timely management of acute bacterial meningitis in the ED. Am J Emerg Med 31:1056–1061. https://doi.org/10.1016/j.ajem.2013.03.042CrossRefPubMed

10.

Bodilsen J, Dalager-Pedersen M, Schønheyder HC, Nielsen H (2016) Time to antibiotic therapy and outcome in bacterial meningitis: a Danish population-based cohort study. BMC Infect Dis 16:392. https://doi.org/10.1186/s12879-016-1711-zCrossRefPubMedPubMedCentral

11.

Tunkel AR, Hartman BJ, Kaplan SL et al (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39:1267–1284. https://doi.org/10.1086/425368CrossRefPubMed

12.

van de Beek D, Cabellos C, Dzupova O et al (2016) ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect 22:S37–S62. https://doi.org/10.1016/j.cmi.2016.01.007CrossRefPubMed

13.

McGill F, Heyderman RS, Michael BD et al (2016) The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect 72:405–438. https://doi.org/10.1016/j.jinf.2016.01.007CrossRefPubMed

14.

Glimåker M, Sjölin J, Åkesson S, Naucler P (2018) Lumbar puncture performed promptly or after neuroimaging in Acute bacterial meningitis in adults: a prospective National Cohort Study evaluating different guidelines. Clin Infect Dis 66:321–328. https://doi.org/10.1093/cid/cix806CrossRefPubMed

15.

Costerus JM, Lemmens CMC, van de Beek D, Brouwer MC (2020) Cranial imaging and lumbar puncture in patients with suspected central nervous system infection. Clin Infect Dis 70:2469–2475. https://doi.org/10.1093/cid/ciz694CrossRefPubMed

16.

Park N, Nigo M, Hasbun R (2022) Comparison of Four International guidelines on the utility of cranial imaging before lumbar puncture in adults with bacterial meningitis. Clin Neuroradiol 32:857–862. https://doi.org/10.1007/s00062-022-01143-4CrossRefPubMed

17.

Glimåker M, Johansson B, Bell M et al (2013) Early lumbar puncture in adult bacterial meningitis - rationale for revised guidelines. Scand J Infect Dis 45:657–663CrossRefPubMed

18.

Cauley KA (2015) Fluoroscopically guided lumbar puncture. Am J Roentgenol 205:W442–W450. https://doi.org/10.2214/AJR.14.14028CrossRef

19.

Health Information and Quality Authority (2023) Report of an inspection against the National Standards for Safer Better Healthcare. Dublin

20.

Hasbun R, Abrahams J, Jekel J, Quagliarello VJ (2001) Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med 345:1727–1733. https://doi.org/10.1056/NEJMoa010399CrossRefPubMed

21.

Davis LE (2018) Acute bacterial meningitis. CONTINUUM: Lifelong Learn Neurol 24:1264–1283. https://doi.org/10.1212/CON.0000000000000660CrossRef

22.

Winkler F, Kastenbauer S, Yousry TA et al (2002) Discrepancies between brain CT imaging and severely raised intracranial pressure proven by ventriculostomy in adults with pneumococcal meningitis. J Neurol 249:1292–1297. https://doi.org/10.1007/s00415-002-0844-8CrossRefPubMed

23.

Larsen L, Poulsen FR, Nielsen TH et al (2017) Use of intracranial pressure monitoring in bacterial meningitis: a 10-year follow up on outcome and intracranial pressure versus head CT scans. Infect Dis 49:356–364. https://doi.org/10.1080/23744235.2016.1269265CrossRef

24.

Costerus JM, Brouwer MC, Sprengers MES et al (2018) Cranial computed tomography, lumbar puncture, and clinical deterioration in bacterial meningitis: a Nationwide Cohort Study. Clin Infect Dis 67:920–926. https://doi.org/10.1093/cid/ciy200CrossRefPubMed

25.

Sturdy S, Miller F, Hogarth S et al (2020) Half a Century of Wilson & Jungner: reflections on the Governance of Population Screening. Wellcome Open Res 5:158. https://doi.org/10.12688/wellcomeopenres.16057.2CrossRefPubMedPubMedCentral

26.

JEFFERSON G (1938) THE TENTORIAL PRESSURE CONE. Arch Neurol Psychiatry 40:857. https://doi.org/10.1001/archneurpsyc.1938.02270110011001CrossRef

27.

April MD, Long B, Koyfman A (2017) Emergency medicine myths: computed tomography of the Head prior to lumbar puncture in adults with suspected bacterial meningitis – due diligence or antiquated practice? J Emerg Med 53:313–321. https://doi.org/10.1016/j.jemermed.2017.04.032CrossRefPubMed

28.

Erbay SH, O’Callaghan MG, Bhadelia R (2005) Is lumbar puncture contraindicated in patients with Chiari I malformation? AJNR Am J Neuroradiol 26:985PubMedPubMedCentral

Titel: Comparison of international guidelines for CT prior to lumbar puncture in patients with suspected meningitis
verfasst von: Fergus O’ Herlihy
Philip J Dempsey
Dora Gorman
Eavan G Muldoon
Brian Gibney
Publikationsdatum: 02.05.2024
Verlag: Springer International Publishing
Erschienen in: Emergency Radiology / Ausgabe 3/2024
Print ISSN: 1070-3004
Elektronische ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-024-02234-0

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