ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2017
Cranial Imaging Before Lumbar Puncture in Adults With Community-Acquired Meningitis: Clinical Utility and Adherence to the Infectious Diseases Society of America Guidelines.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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16 citing papers in PubMed.
- Lumbar Puncture and Brain Herniation in Acute Bacterial Meningitis: An Updated Narrative Review.Journal of intensive care medicine · 2026Review
- Bacterial meningoencephalitis following allogeneic hematopoietic stem cell transplantation: A case report and literature review.Experimental and therapeutic medicine · 2026Article
- Occult clival chordoma initially unrecognized on MRI presenting with cerebrospinal fluid rhinorrhea: a case report.Frontiers in oncology · 2026Article
- Overuse of head CT scans in non-traumatic paediatric cases in the West Bank, Palestine: a cross-sectional study.BMJ open · 2025Article
- The diagnostic role of elevated serum cryptococcal antigen titers in patients with suspected cryptococcal meningitis when lumbar puncture is contraindicated: A case report.Medical mycology case reports · 2025Article
- A multifaceted intervention to improve diagnosis and early management of hospitalised patients with suspected acute brain infections in Brazil, India, and Malawi: an international multicentre intervention study.Lancet (London, England) · 2025Observational
- Presentation, Management, and Outcome of Tick-Borne Encephalitis in Patients Referred to Infectious Diseases or Neurology.Journal of clinical medicine · 2024Article
- Computed Tomography of the Head Before Lumbar Puncture in Adults With Suspected Meningitis in High-HIV Prevalence Settings.Open forum infectious diseases · 2024Article
- Comparison of international guidelines for CT prior to lumbar puncture in patients with suspected meningitis.Emergency radiology · 2024Article
- Neuroimaging Patterns of Intracranial Infections: Meningitis, Cerebritis, and Their Complications.Neuroimaging clinics of North America · 2023Review
- Temporal Bone Skull Base Defects-The Value and Importance of Early Based Detection to Prevent Late Costly Morbidity and Mortality.Journal of neurological surgery. Part B, Skull base · 2022Review
- Article
- Early Intracranial Hemorrhage Predicts Poor Clinical Outcome in Community-Acquired Bacterial Meningitis.Frontiers in neurology · 2022Article
- Cranial Imaging and Lumbar Puncture in Patients With Suspected Central Nervous System Infection.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Article
- Aseptic meningitis in adults and children: Diagnostic and management challenges.Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology · 2017Article
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Abstract
BACKGROUND.: The Infectious Diseases Society of America (IDSA) guidelines delineate criteria for the use of computed tomography (CT) scan of the head before lumbar puncture (LP) in adults with community-acquired meningitis (CAM). There are limited data to document adherence to these guidelines and assess the clinical utility of brain imaging. METHODS.: This was a retrospective analysis from January 2005 to January 2010 in Houston, Texas. RESULTS.: Among 614 adults with CAM, 407 patients (66.3%) did not have an indication for a head CT scan and 207 (33.7%) did. Patients with a CT scan indication were older, had more comorbidities, were sicker, and had more urgent treatable etiologies and adverse clinical outcomes (P < .001). A CT scan was ordered before the LP in 549 patients (89%). Overall, clinicians did not adhere to clinical guidelines in 368 of 614 (60%) subjects. A CT of the head was ordered when not indicated in 355 of 549 patients (64%), and not done when indicated in 13 of 207 patients (0.6%). CT of the head revealed intracranial abnormalities in 35 of 193 patients (18.1%) with an indication for brain imaging, compared with only 2 of 356 (0.05%) with no indication (P < .05). Major intracranial findings were seen in only 15 of 549 (2.7%) patients, all with an indication for brain imaging. Furthermore, only 8 patients had abnormalities that affected clinical management. CONCLUSIONS.: Most clinicians do not adhere to IDSA guidelines, delaying diagnostic LP and increasing costs. Usefulness of head CT in patients with CAM without an indication for imaging is limited and has no impact in clinical management.
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