Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland.
Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.
Emerg Radiol. 2024 Jun;31(3):373-379. doi: 10.1007/s10140-024-02234-0. Epub 2024 May 2.
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.
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.
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.
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.
比较多项国际指南在选择疑似脑膜炎患者行腰椎穿刺（LP）前行头颅 CT 的表现，重点关注对 LP 禁忌证的识别。
回顾性分析 2013 年 3 月至 2023 年 3 月间在急诊科就诊的 196 例疑似脑膜炎患者，所有患者均在 LP 前行头颅 CT。通过将影像学标准与就诊时的临床特征进行交叉参考，评估英国联合专业学会指南（UK）、欧洲临床微生物学和传染病学会（ESCMID）和美国传染病学会（IDSA）指南。评估每种指南对 CT 显示脑移位病例推荐神经影像学检查的敏感性，以及正常研究和偶然或虚假发现的数量。
196 例患者中，2/196（1%）例患者 CT 异常，存在脑移位证据，14/196（7%）例患者 CT 异常，但无脑移位。UK、ESCMID 和 IDSA 指南分别建议对 10%、14%和 33%的病例进行影像学检查。所有 3 种指南均建议对 2/2（100%）脑移位病例行 LP 前影像学检查。IDSA 指南建议进行更多的 CT 研究，正常结果（分别为 59 比 16 和 24 比 UK 和 ESCMID 指南）和无脑移位的 CT 异常（分别为 4 比 1 和 2 比 UK 和 ESCMID 指南）比其他指南更多。
UK、ESCMID 和 IDSA 指南均能有效地识别出从 LP 前行头颅 CT 中获益的小部分患者。遵循更具选择性的 UK/ESCMID 指南可以限制正常研究和偶然或虚假 CT 发现的数量。
