oa Computed tomography (CT) scanning of the head before lumbar puncture in children with suspected meningitis: A prospective observational study

Background: Cranial computed tomography (CT) scan is a commonly performed neuroimaging prior to lumbar puncture (LP) in children with suspected meningitis to rule out intracranial hypertension or space occupying lesions. The purpose of this study was to assess the accuracy of physicians' prediction of CT abnormal cerebral findings in pediatric meningitis.

Subjects and methods: A prospective observational study design was performed over a 12-month period. Eligible patients were admitted to the Emergency Department (ED) where a structured questionnaire was filled independently by two physicians before undergoing cranial CT scan and prior to LP.

Results: In this study, 72 patients met the inclusion criteria with a mean age of 7.04 ± 3.38 years. The mean physicians' prediction score of abnormal CT findings was 6.0 ± 3.0 vs. 2.48 ± 2.01 of no abnormalities (difference 3.5 ± 1.0 (95% CI: 1.5, 5.5; p = 0.001). Relative risk of CT abnormalities associated with decreased level of consciousness was 7.33 (95% CI: 1.5, 33.67), Glasgow coma scale was 23.3 (95% CI: 7.7, 70.7), and abnormal posture was 8.9 (95% CI: 1.9, 41.7). Apart from mild headache (2.8%), vomiting (2.8%), dizziness (4.2%), no serious complications related to LP procedure have been reported.

Conclusion: Physician's clinical decision could predict absence of abnormal findings on cranial CT scan before LP in children with suspected meningitis. Our results suggest that LP could be performed with avoidance of CT scanning of the head in pediatric meningitis provided the presence of normal consciousness level, Glasgow coma scale ≥ 13 and normal neurologic examination.