Clinical Edge

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CT Scan Before Lumbar Puncture in Adults with CAM

Clin Infect Dis; ePub 2017 Mar 21; Salazar, et al

Most clinicians do not adhere to Infectious Diseases Society of America (IDSA) guidelines for the use of computed tomography (CT) scan of the head before lumbar puncture (LP) in adults with community-acquired meningitis (CAM), thus delaying diagnostic LP and increasing costs, a recent study found. The retrospective analysis from January 2005 to January 2010 included 614 adults with CAM. Researchers found:

  • 407 (66.3%) patients did not have an indication for a head CT scan; 207 (33.7%) did.
  • A CT scan was ordered before the LP in 549 (89%) patients.
  • Overall, clinicians did not adhere to IDSA guidelines in 368/614 (60%) patients.
  • CT of the head was ordered when not indicated in 355/549 (64%), and not done when indicated in 13/207 (0.6%) patients.
  • Major intracranial findings were seen in only 15/549 (2.7%) patients, all with an indication for brain imaging.

Citation:

Salazar L, Hasbun R. Cranial imaging before lumbar puncture in adults with community-acquired meningitis: Clinical utility and adherence to the Infectious Diseases Society of America guidelines. [Published online ahead of print March 21, 2017]. Clin Infect Dis. doi:10.1093/cid/cix240.