CT head before LP in meningitis-myth or due diligence?
It has become a usual norm to routinely perform brain imaging in
patients with suspected meningitis. Hasburn et al.,65and Gopal et al.,66 in their study on 301 and 111
patients respectively, found that performing CT before LP in patients
with following clinical features viz; age more than 60 years, history of
central nervous system disease, severely immunocompromised, impaired
consciousness, new onset seizures, or any focal neurological deficits,
resulted in 41 % and 31.5 % potential reduction in the volume of
CTs.65,66 This also translated into a reduction in the
time interval between the patient being admitted and the first dose of
antibiotic, which can have a significant impact on mortality. IDSA
survey in 2016 also noted that instead of adhering to the guidelines,
majority of physicians order imaging before LP thereby delaying
diagnosis and administration of antibiotics and hence increase
in-hospital expenditure.67 Certain clinical features
(as discussed above ) should warrant performing advanced imaging before
LP in suspected meningitis instead of routinely performing imaging in
every patient before LP.