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Identifying Adults with Meningitis Who Do Not Need Cranial Imaging Prior to Lumbar Puncture

Description

In adults suspected of having meningitis, cranial imaging is frequently done to identify intracranial mass lesions prior to lumbar puncture to minimize the risk of herniation. By identifying factors associated with positive imaging studies, those patients needing and those not needing imaging studies can be identified. Not performing unnecessary imaging studies results in more cost-effective medical care.


 

Factors associated with positive imaging studies on logistic regression modeling:

(1) comorbidity

(2) history of a previous CNS lesion

(3) recent seizure (< 1 week)

(4) cranial nerve abnormality

(5) focal motor defect on neurologic exam

 

Additional factors noted from bivariate analysis to be statistically associated with an abnormal head CT:

(6) immunosuppression

(7) AIDS defining illness

(8) abnormal mental status

 

Patients showing no risk for abnormal imaging studies:

(1) immunocompetent

(2) no history of CNS lesion

(3) a normal neurological examination

(4) no clinical evidence of intracranial hypertension (normal systemic blood pressure and no papilledema)

 

In the study population, approximately 40% of patients were in the no risk group and did not need imaging studies prior to lumbar puncture.

 


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Specialty

ICD-10