Abstract：
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目的：比较多种国际指南在疑似脑膜炎患者腰椎穿刺（LP）前选择头部CT的表现，专注于识别即时LP的潜在禁忌症。
方法：回顾性研究，对2013年3月至2023年3月期间到急诊科就诊并在LP之前接受头部CT检查的196例疑似脑膜炎患者进行了研究。英国联合专家协会指南(英国),欧洲临床微生物学和传染病学会（ESCMID）和美国传染病学会（IDSA）指南通过交叉参考影像学标准与演示时的临床特征进行评估。评估了每个指南在CT脑移位病例中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。
结果：2/196（1％）患者的CT异常，有脑移位的证据，而14/196（7％）在CT上有其他异常，无脑移位。英国,ESCMID和IDSA指南建议在10%进行成像，分别为14%和33%的病例。所有三个指南都建议在2/2（100％）的脑移位病例中进行LP前成像。IDSA指南建议与其他指南相比，更多的CT研究发现正常（英国和ESCMID指南分别为59vs16和24）和无脑移位的CT异常（分别为4vs1和2）。
结论：英国，ESCMID和IDSA指南均可有效识别在LP之前受益于头部CT的小队列患者。遵循更具选择性的UK/ESCMID指南限制了正常研究的数量以及偶然或虚假的CT发现。
方法：回顾性研究，对2013年3月至2023年3月期间到急诊科就诊并在LP之前接受头部CT检查的196例疑似脑膜炎患者进行了研究。英国联合专家协会指南(英国),欧洲临床微生物学和传染病学会（ESCMID）和美国传染病学会（IDSA）指南通过交叉参考影像学标准与演示时的临床特征进行评估。评估了每个指南在CT脑移位病例中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。
结果：2/196（1％）患者的CT异常，有脑移位的证据，而14/196（7％）在CT上有其他异常，无脑移位。英国,ESCMID和IDSA指南建议在10%进行成像，分别为14%和33%的病例。所有三个指南都建议在2/2（100％）的脑移位病例中进行LP前成像。IDSA指南建议与其他指南相比，更多的CT研究发现正常（英国和ESCMID指南分别为59vs16和24）和无脑移位的CT异常（分别为4vs1和2）。
结论：英国，ESCMID和IDSA指南均可有效识别在LP之前受益于头部CT的小队列患者。遵循更具选择性的UK/ESCMID指南限制了正常研究的数量以及偶然或虚假的CT发现。
