Romer F K
Lancet. 1977 Aug 13;2(8033):345-7. doi: 10.1016/s0140-6736(77)91498-2.
In 104 patients with bacterial meningitis admitted to departments of general medicine, the diagnosis before admission and the effect of previous antibiotic treatment were studied. Antibiotic therapy begun before admission in 30 patients did not affect the ability to make a bacteriological diagnosis. The duration of illness before admission was longer in the treated than in the untreated group. About 50% of the patients were admitted with diagnoses other than meningitis, although half these patients had distinct meningeal signs on arrival at hospital. In the whole series, 76% had meningeal signs on arrival. On the other hand, 95% of 108 patients with lymphocytic meningitis were admitted with a diagnosis of meningitis. The only significant clinical finding in the wrongly diagnosed group was a temperature higher than 40 degrees C on admission to hospital. The diagnosis before admission was not related to the treatment given. The findings illustrate the difficulties of diagnosing bacterial meningitis in the home.
对104例入住普通内科的细菌性脑膜炎患者，研究了入院前的诊断情况及先前抗生素治疗的效果。30例入院前开始抗生素治疗的患者，其细菌学诊断能力未受影响。治疗组入院前的病程长于未治疗组。约50%的患者入院诊断不是脑膜炎，尽管其中一半患者入院时具有明显的脑膜刺激征。在整个系列中，76%的患者入院时有脑膜刺激征。另一方面，108例淋巴细胞性脑膜炎患者中，95%入院诊断为脑膜炎。误诊组唯一显著的临床发现是入院时体温高于40℃。入院前的诊断与所给予的治疗无关。这些发现说明了在家中诊断细菌性脑膜炎的困难。
