背景:关于在疑似脑膜炎的成年人进行腰椎穿刺(LP)前进行头部计算机断层扫描(CT)扫描的国际指南,但没有研究比较它们识别颅内异常的能力。
方法:2004年12月至2019年5月在休斯敦16家医院进行的202例社区获得性细菌性脑膜炎成人患者的回顾性研究,以比较4种指南识别次要和主要颅内发现的能力。在CT检查结果改变管理的情况下,和患有脑疝的患者。
结果:在69(34.1%)和24(11.8%)的患者中发现了次要和主要的颅内发现,分别。总共有9个(37.5%)的主要颅内发现提示了神经外科手术。共有四名(1.9%)患者患有脑疝。美国传染病(IDSA)英国(UK),欧洲临床微生物学和传染病学会(ESCMID),瑞典的颅骨成像指南达到了92.1%,54%,41.6%,在23.3%的患者中,分别。IDSA,英国,欧洲,瑞典指南错过了0%,20.8%,41.7%,70.8%的主要颅内发现和0,1,3和4的9例患者,促使神经外科干预,分别。所有四名脑疝患者均符合所有四项指南的标准。
结论:在四个国际准则中,只有IDSA关于颅骨成像的建议没有遗漏任何重大颅内异常或任何促使神经外科介入的发现,但所有指南都确定了脑疝.
BACKGROUND: International
guidelines exist for obtaining a head computed tomography (CT) scan before a lumbar puncture (LP) in adults with suspected meningitis but there are no studies comparing them in their ability to identify intracranial abnormalities.
METHODS: A retrospective study of 202 cases of adults with community-acquired bacterial meningitis at 16 hospitals in Houston from December 2004 until May 2019 to compare the 4
guidelines\' ability in identifying minor and major intracranial findings, cases in which CT findings changed management, and patients who suffered cerebral herniation.
RESULTS: Minor and major intracranial findings were seen in 69 (34.1%) and in 24 (11.8%) of the patients, respectively. A total of nine (37.5%) of the major intracranial findings prompted a neurosurgical intervention. A total of four (1.9%) patients had cerebral herniation. The Infectious Diseases of America (IDSA), the United Kingdom (UK), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), and the Swedish
guidelines for cranial imaging were met in 92.1%, 54%, 41.6%, and in 23.3% of the patients, respectively. The IDSA, UK, European, and the Swedish guidelines missed 0%, 20.8%, 41.7%, and 70.8% of the major intracranial findings and 0, 1, 3 and 4 of the 9 patients that prompted a neurosurgical intervention, respectively. All four patients with cerebral herniation met the criteria for all four
guidelines.
CONCLUSIONS: Out of the four international
guidelines, only the IDSA recommendations for cranial imaging did not miss any major intracranial abnormality or any finding that prompted a neurosurgical intervention but all guidelines identified herniation.