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class="bkr_bib"><h1 id="_NBK604144_"><span itemprop="name">Evidence review for factors associated with brain herniation</span></h1><div class="subtitle">Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management</div><p><b>Evidence review B4</b></p><p><i>NICE Guideline, No. 240</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2024 Mar</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-5758-3</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2024.</div></div><div class="bkr_clear"></div></div><div id="niceng240er8.s1"><h2 id="_niceng240er8_s1_">Factors associated with brain herniation</h2><div id="niceng240er8.s1.1"><h3>Review question</h3><p>What factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis?</p><div id="niceng240er8.s1.1.1"><h4>Introduction</h4><p>Bacterial meningitis is a rare but serious infection, which can occur in any age group. Early recognition of the condition requires a high index of suspicion.</p><p>Cerebrospinal fluid (CSF) investigations are crucial for the diagnosis of bacterial meningitis, and obtaining CSF samples for urgent investigation should be prioritised whenever a diagnosis of bacterial meningitis is being considered.</p><p>Bacterial meningitis may cause raised intracranial pressure, which can represent a risk for brain herniation following lumbar puncture. The aim of this review is to evaluate what factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis.</p></div><div id="niceng240er8.s1.1.2"><h4>Summary of the protocol</h4><p>See <a href="/books/NBK604144/table/niceng240er8.tab1/?report=objectonly" target="object" rid-ob="figobniceng240er8tab1">Table 1</a> for a summary of the Population, Prognostic factors, Comparison and Outcome characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng240er8tab1"><a href="/books/NBK604144/table/niceng240er8.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img" rid-ob="figobniceng240er8tab1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng240er8.tab1"><a href="/books/NBK604144/table/niceng240er8.tab1/?report=objectonly" target="object" rid-ob="figobniceng240er8tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol. </p></div></div><p>For further details see the review protocol in <a href="#niceng240er8.appa">appendix A</a>.</p></div><div id="niceng240er8.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng240er8.appa">appendix A</a> and the <a href="/books/NBK604144/bin/NG240-Methods-pdf.pdf">methods</a> document (supplementary document 1).</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng240er8.s1.1.4"><h4>Prognostic evidence</h4><div id="niceng240er8.s1.1.4.1"><h5>Included studies</h5><p>Two studies were included for this review, 1 case-control study (<a class="bibr" href="#niceng240er8.ref1" rid="niceng240er8.ref1">Benjamin 1988</a>) but only cases (children with meningitis that died) from that study included in this review, and 1 retrospective cohort study (<a class="bibr" href="#niceng240er8.ref2" rid="niceng240er8.ref2">Horwitz 1980</a>).</p><p>Studies with univariate analyses were included as no studies with multivariate analyses were identified.</p><p>The included studies are summarised in <a href="/books/NBK604144/table/niceng240er8.tab2/?report=objectonly" target="object" rid-ob="figobniceng240er8tab2">Table 2</a>.</p><p>One study reported fatal brain herniation based on post-mortem diagnosis of coning (<a class="bibr" href="#niceng240er8.ref1" rid="niceng240er8.ref1">Benjamin 1988</a>), and 1 reported brain herniation using clinical diagnostic criteria (<a class="bibr" href="#niceng240er8.ref2" rid="niceng240er8.ref2">Horwitz 1980</a>).</p><p>Both studies reported seizures and reduced consciousness as potential risk factors. One study used parental assessment of ‘difficult to wake’ to indicate reduced consciousness (<a class="bibr" href="#niceng240er8.ref1" rid="niceng240er8.ref1">Benjamin 1988</a>), and 1 used coma for this risk factor (<a class="bibr" href="#niceng240er8.ref2" rid="niceng240er8.ref2">Horwitz 1980</a>). One study was conducted in children (<a class="bibr" href="#niceng240er8.ref1" rid="niceng240er8.ref1">Benjamin 1988</a>) and 1 study was conducted in babies and children (<a class="bibr" href="#niceng240er8.ref2" rid="niceng240er8.ref2">Horwitz 1980</a>).</p><p>See the literature search strategy in <a href="#niceng240er8.appb">appendix B</a> and study selection flow chart in <a href="#niceng240er8.appc">appendix C</a>.</p></div><div id="niceng240er8.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng240er8.appj">appendix J</a>.</p></div></div><div id="niceng240er8.s1.1.5"><h4>Summary of included studies</h4><p>Summaries of the studies that were included in this review are presented in <a href="/books/NBK604144/table/niceng240er8.tab2/?report=objectonly" target="object" rid-ob="figobniceng240er8tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng240er8tab2"><a href="/books/NBK604144/table/niceng240er8.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img" rid-ob="figobniceng240er8tab2"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng240er8.tab2"><a href="/books/NBK604144/table/niceng240er8.tab2/?report=objectonly" target="object" rid-ob="figobniceng240er8tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See the full evidence tables in <a href="#niceng240er8.appd">appendix D</a>. No meta-analysis was conducted (and so there are no forest plots in <a href="#niceng240er8.appe">appendix E</a>).</p></div><div id="niceng240er8.s1.1.6"><h4>Summary of the evidence</h4><p>This section is a narrative summary of the findings of the review, as presented in the GRADE tables in <a href="#niceng240er8.appf">appendix F</a>. For details of the committee's confidence in the evidence and how this affected recommendations, see <a href="#niceng240er8.s1.1.9">The committee’s discussion and interpretation of the evidence</a>.</p><p>The evidence was assessed as being very low quality due to high or moderate risk of bias in most domains (for example, bias arising from study participation due to lack of reporting of baseline characteristics and study confounding due to lack of adjustment for confounders), and imprecision due to the very low numbers of events. The evidence was stratified by age and definition of brain herniation. See the GRADE tables in <a href="#niceng240er8.appf">appendix F</a> for the certainty of the evidence for each individual outcome following lumbar puncture.</p><p>Presence of seizures and reduced consciousness were associated with <i>any</i> brain herniation in babies and children. There was no evidence of an association between seizures or reduced consciousness and <i>fatal</i> brain herniation in children in the evidence reviewed. However, the findings were very seriously imprecise.</p><p>No studies reported data for the other prognostic factors in the protocol (new focal neurologic deficit, papilloedema, continuous seizures, hypertension, bradycardia, bulging fontanelle, decorticate or decerebrate posturing, irregular respiratory pattern, shock), and no evidence was available for adults.</p><p>See <a href="#niceng240er8.appf">appendix F</a> for full GRADE tables.</p></div><div id="niceng240er8.s1.1.7"><h4>Economic evidence</h4><div id="niceng240er8.s1.1.7.1"><h5>Included studies</h5><p>A single economic search was undertaken for all topics included in the scope of this guideline, but no economic studies were identified which were applicable to this review question.</p></div></div><div id="niceng240er8.s1.1.8"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation. This was because this review does not involve a comparison of competing courses of action.</p></div><div id="niceng240er8.s1.1.9"><h4>The committee's discussion and interpretation of the evidence</h4><div id="niceng240er8.s1.1.9.1"><h5>The outcomes that matter most</h5><p>This review aimed to identify factors associated with brain herniation following lumbar puncture in people with suspected bacterial meningitis; therefore, brain herniation was selected as the critical outcome. The committee included both any brain herniation and fatal brain herniation as outcomes as they agreed it was important to identify any differences in risk factors dependant on the outcome of the herniation.</p></div><div id="niceng240er8.s1.1.9.2"><h5>The quality of the evidence</h5><p>The quality of the evidence was assessed with GRADE methodology and was rated as very low quality for all reported outcomes. This was due to serious imprecision around the estimated effects due to small numbers of events and risk of bias arising from the selection of participants, and insufficient reporting of baseline characteristics or adjustment for confounding factors.</p><p>No evidence was identified for new focal neurologic deficit, papilloedema, continuous seizures, hypertension, bradycardia, bulging fontanelle, decorticate or decerebrate posturing, irregular respiratory pattern, or shock.</p></div><div id="niceng240er8.s1.1.9.3"><h5>Benefits and harms</h5><p>Based on their clinical knowledge, the committee highlighted that raised intracranial pressure is a contraindication for lumbar puncture due to the risk of brain herniation.</p><p>The committee considered the evidence for factors associated with brain herniation following lumbar puncture. The evidence showed that reduced consciousness and the presence of seizures were associated with <i>any</i> brain herniation in babies and children. These findings were consistent with the clinical expertise of the committee as they are recognised signs of raised intracranial pressure. The committee agreed that to mitigate these risks, imaging should be performed before lumbar puncture if the person has seizures. The committee also recommended that imaging should be performed prior to lumbar puncture if the person has a Glasgow Coma Scale (GCS) score of 9 or less, or there has been a progressive and sustained or rapid fall in the level of consciousness. The committee discussed defining the deteriorating level of consciousness as a fall of 3 GCS levels but agreed that this was not possible as it depends on the domain, for example, if a person dropped from a score of 6 to 4 on the motor dimension this would be clinically significant but would not meet this definition. The committee emphasised that a fluctuating level of consciousness would not mean that imaging would be needed, but clarified in the recommendations that it was a consistently falling level of consciousness that was an indicator for imaging. The committee noted that in the evidence reviewed, a study found no association between reduced consciousness or seizures and <i>fatal</i> brain herniation in children, however as the findings were seriously imprecise, they agreed that this should not be taken as definitive evidence of absence of association.</p><p>The committee noted there are other well documented signs of significant abnormal neurology, which could be features of raised intracranial pressure (and a risk factor for brain herniation), including posturing and abnormal pupillary reactions, and the committee agreed that where these signs are present imaging should be performed.</p></div><div id="niceng240er8.s1.1.9.4"><h5>Cost effectiveness and resource use</h5><p>This review question did not consider decisions between competing alternatives and therefore is not directly relevant to the tools of economic evaluation. The recommendations based on this review primarily provide advice to healthcare professionals on the contraindications to lumbar puncture. The committee considered their recommendations would promote cost effective care by highlighting the circumstances when neuroimaging prior to lumbar puncture should be considered to avoid the potential harms when a person has features of brain herniation. A recent retrospective cohort study in the UK (<a class="bibr" href="#niceng240er8.ref3" rid="niceng240er8.ref3">Ellis 2022</a>) in a population with community acquired meningitis reported that contraindications to immediate lumbar puncture were uncommon, being present for 20% of patients. The committee considered that the recommendations largely reinforce current best practice and knowledge and therefore they did not believe they would have a significant resource impact.</p></div></div><div id="niceng240er8.s1.1.10"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendation 1.4.7. Other evidence supporting this recommendation can be found in the evidence review on the role of neuroimaging prior to lumbar puncture (see evidence review B5).</p></div></div><div id="niceng240er8.rl.r1"><h3>References - included studies</h3><ul class="simple-list"><div id="niceng240er8.rl.r1.1"><h4>Prognostic</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng240er8.ref1"><p id="p-81">
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<strong>Benjamin 1988</strong>
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</p>Benjamin
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C. M., Newton
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R. W., Clarke
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M. A., Risk factors for death from meningitis, British Medical Journal Clinical Research Ed.Br Med J (Clin Res Ed), 296, 20, 1988 [<a href="/pmc/articles/PMC2544649/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2544649</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/3122918" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3122918</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng240er8.ref2"><p id="p-82">
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<strong>Horwitz 1980</strong>
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</p>Horwitz
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S. J., Boxerbaum
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B., O'Bell
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J., Cerebral herniation in bacterial meningitis in childhood, Annals of Neurology, 7, 524–8, 1980
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[<a href="https://pubmed.ncbi.nlm.nih.gov/6776873" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6776873</span></a>]</div></p></li></ul></div><div id="niceng240er8.rl.r1.2"><h4>Economic</h4><ul class="simple-list"><p>No studies were identified which were applicable to this review question.</p></ul></div><div id="niceng240er8.rl.r1.3"><h4>Other</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng240er8.ref3"><p id="p-84">
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<strong>Ellis 2022</strong>
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</p>Ellis
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J., Harvey
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D., Defres
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S., et al
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Clinical management of community acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR). BMJ Open
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2022;12: e062698. doi:10.1136/bmjopen-2022-062698 [<a href="/pmc/articles/PMC9315913/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9315913</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35831140" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35831140</span></a>] [<a href="http://dx.crossref.org/10.1136/bmjopen-2022-062698" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></p></li></ul></div></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng240er8.appa"><h3>Appendix A. Review protocols</h3><p id="niceng240er8.appa.et1"><a href="/books/NBK604144/bin/niceng240er8-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: What factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis?</a><span class="small"> (PDF, 257K)</span></p></div><div id="niceng240er8.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng240er8.appb.et1"><a href="/books/NBK604144/bin/niceng240er8-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review question: What factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis?</a><span class="small"> (PDF, 244K)</span></p></div><div id="niceng240er8.appc"><h3>Appendix C. Prognostic evidence study selection</h3><p id="niceng240er8.appc.et1"><a href="/books/NBK604144/bin/niceng240er8-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for review question: What factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis?</a><span class="small"> (PDF, 97K)</span></p></div><div id="niceng240er8.appd"><h3>Appendix D. Evidence tables</h3><p id="niceng240er8.appd.et1"><a href="/books/NBK604144/bin/niceng240er8-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: What factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis?</a><span class="small"> (PDF, 162K)</span></p></div><div id="niceng240er8.appe"><h3>Appendix E. Forest plots</h3><div id="niceng240er8.appe.s1"><h4>Forest plots for review question: What factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis?</h4><p>No meta-analysis was conducted for this review question and so there are no forest plots.</p></div></div><div id="niceng240er8.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng240er8.appf.et1"><a href="/books/NBK604144/bin/niceng240er8-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">GRADE tables for review question: What factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis?</a><span class="small"> (PDF, 150K)</span></p></div><div id="niceng240er8.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng240er8.appg.et1"><a href="/books/NBK604144/bin/niceng240er8-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for review question: What factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis?</a><span class="small"> (PDF, 98K)</span></p></div><div id="niceng240er8.apph"><h3>Appendix H. Economic evidence tables</h3><div id="niceng240er8.apph.s1"><h4>Economic evidence tables for review question: What factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="niceng240er8.appi"><h3>Appendix I. Economic model</h3><div id="niceng240er8.appi.s1"><h4>Economic model for review question: What factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="niceng240er8.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng240er8.appj.s1"><h4>Excluded studies for review question: What factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis?</h4><div id="niceng240er8.appj.s1.1"><h5>Excluded prognostic studies</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng240er8appjtab1"><a href="/books/NBK604144/table/niceng240er8.appj.tab1/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img" rid-ob="figobniceng240er8appjtab1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng240er8.appj.tab1"><a href="/books/NBK604144/table/niceng240er8.appj.tab1/?report=objectonly" target="object" rid-ob="figobniceng240er8appjtab1">Table 7</a></h4><p class="float-caption no_bottom_margin">Excluded studies and reasons for their exclusion. </p></div></div></div><div id="niceng240er8.appj.s1.2"><h5>Excluded economic studies</h5><p>No studies were identified which were applicable to this review question.</p></div></div></div><div id="niceng240er8.appk"><h3>Appendix K. Research recommendations – full details</h3><div id="niceng240er8.appk.s1"><h4>Research recommendations for review question: What factors (individually or in combination) are associated with an increased risk of brain herniation following lumbar puncture in people with suspected bacterial meningitis?</h4><p>No research recommendation was made for this review.</p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence review underpinning recommendation 1.4.7 in the NICE guideline</p><p>This evidence review was developed by NICE</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2024.</div><div class="small"><span class="label">Bookshelf ID: NBK604144</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/38838174" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">38838174</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng240er8tab1"><div id="niceng240er8.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604144/table/niceng240er8.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng240er8.tab1_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Population</b>
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All adults, young people, children and babies (excluding neonates defined as aged 28 days old and younger) with suspected bacterial meningitis who have undergone a lumbar puncture</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Prognostic factors</b>
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">One or more of the following factors:<ul><li class="half_rhythm"><div>A new focal neurologic deficit</div></li><li class="half_rhythm"><div>Papilloedema</div></li><li class="half_rhythm"><div>Seizure</div></li><li class="half_rhythm"><div>Continuous seizures/status epilepticus</div></li><li class="half_rhythm"><div>Hypertension</div></li><li class="half_rhythm"><div>Bradycardia</div></li><li class="half_rhythm"><div>Reduced or fluctuating level of consciousness</div></li><li class="half_rhythm"><div>Bulging fontanelle</div></li><li class="half_rhythm"><div>Decorticate or decerebrate posturing</div></li><li class="half_rhythm"><div>Irregular respiratory pattern/respiratory distress/Cheyne-Stokes breathing/apnoea</div></li><li class="half_rhythm"><div>Shock</div></li></ul></td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<b>Comparison</b>
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Absence of risk factor</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<b>Outcome</b>
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Critical</b>
|
|
<ul><li class="half_rhythm"><div>Risk ratios for fatal brain herniation</div></li><li class="half_rhythm"><div>Odds ratios for fatal brain herniation</div></li><li class="half_rhythm"><div>Risk ratios for any brain herniation</div></li><li class="half_rhythm"><div>Odds ratios for any brain herniation</div></li></ul>
|
|
</p>
|
|
<p>
|
|
<b>Important</b>
|
|
</p>
|
|
<p>None</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng240er8tab2"><div id="niceng240er8.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies.</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604144/table/niceng240er8.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng240er8.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng240er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng240er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng240er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk factor</th><th id="hd_h_niceng240er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng240er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng240er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng240er8.ref1" rid="niceng240er8.ref1">Benjamin 1988</a>
|
|
</p>
|
|
<p>Case-control study [only cases included in this review]</p>
|
|
<p>UK</p>
|
|
</td><td headers="hd_h_niceng240er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=19</p>
|
|
<p>Cases: Children with meningitis that died [Matched controls were not of interest for this review as there was no data on brain herniation for this group]</p>
|
|
<p>Age: NR</p>
|
|
</td><td headers="hd_h_niceng240er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Seizure (fits on admission to hospital)</div></li><li class="half_rhythm"><div>Reduced consciousness (parental report ‘difficult to wake at home’)</div></li></ul>
|
|
</td><td headers="hd_h_niceng240er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Fatal brain herniation</div></li></ul>
|
|
</td><td headers="hd_h_niceng240er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>No information on difference in age based on presence and absence of prognostic factor.</p>
|
|
<p>Bacteria identified in 13 of the cases</p>
|
|
<p>Post-mortem diagnosis.</p>
|
|
</td></tr><tr><td headers="hd_h_niceng240er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng240er8.ref2" rid="niceng240er8.ref2">Horwitz 1980</a>
|
|
</p>
|
|
<p>Retrospective cohort study</p>
|
|
<p>USA</p>
|
|
</td><td headers="hd_h_niceng240er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=302</p>
|
|
<p>Babies and children aged 1 month to 16 years admitted to hospital with bacterial meningitis</p>
|
|
<p>Age: NR</p>
|
|
</td><td headers="hd_h_niceng240er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Seizure</div></li><li class="half_rhythm"><div>Reduced consciousness (defined as coma)</div></li></ul>
|
|
</td><td headers="hd_h_niceng240er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Any brain herniation</div></li></ul>
|
|
</td><td headers="hd_h_niceng240er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>No matching or adjustment for confounding factors.</p>
|
|
<p>Clinical diagnosis based on review of case notes.</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">NR: not reported</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng240er8appjtab1"><div id="niceng240er8.appj.tab1" class="table"><h3><span class="label">Table 7</span><span class="title">Excluded studies and reasons for their exclusion</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604144/table/niceng240er8.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng240er8.appj.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Adriani
|
|
K. S., Brouwer
|
|
M. C., van der Ende
|
|
A., van de Beek
|
|
D., Bacterial meningitis in pregnancy: Report of six cases and review of the literature, Clinical Microbiology and Infection, 18, 345–351, 2012
|
|
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/21375656" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21375656</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: case reports from clinical practice and a nonsystematic literature review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Adriani
|
|
K. S., van de Beek
|
|
D., Brouwer
|
|
M. C., Spanjaard
|
|
L., de Gans
|
|
J., Community-acquired recurrent bacterial meningitis in adults, Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 45, e46–51, 2007
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/17682979" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17682979</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No outcomes of interest for review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Beg
|
|
M., Ali
|
|
S., Ahmad
|
|
S., Akhtar
|
|
N., A study of computed tomography of head before lumbar puncture in patients with suspected meningitis, Journal, Indian Academy of Clinical Medicine, 8, 355–359, 2007
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Country not of interest for review: not an OECD high-income country. Study investigated whether clinical features predict CT abnormalities.</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bouvier
|
|
G., Cour-Andlauer
|
|
F., Mottolese
|
|
C., Teyssedre
|
|
S., Javouhey
|
|
E., Incidence of raised intracranial pressure in children<2 years admitted for severe brain injury, Intensive Care Medicine, 2), S379, 2011
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference paper</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Costerus
|
|
J. M., Brouwer
|
|
M. C., Van Der Ende
|
|
A., Van De Beek
|
|
D., Community-acquired bacterial meningitis in adults with cancer or a history of cancer, NeurologyNeurology, 86, 860–866, 2016 [<a href="https://pubmed.ncbi.nlm.nih.gov/26802096" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26802096</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population does not meet the inclusion criteria</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Costerus
|
|
J., Brouwer
|
|
M., Sprengers
|
|
M., Roosendaal
|
|
S., Van Der Ende
|
|
A., Van De Beek
|
|
D., Cerebral herniation after lumbar puncture in adults with bacterial meningitis, European Journal of Neurology, 24, 38, 2017
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Costerus
|
|
Joost M., Brouwer
|
|
Matthijs C., Sprengers
|
|
Marieke E. S., Roosendaal
|
|
Stefan D., van der Ende
|
|
Arie, van de Beek
|
|
Diederik, Cranial Computed Tomography, Lumbar Puncture, and Clinical Deterioration in Bacterial Meningitis: A Nationwide Cohort Study, Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 67, 920–926, 2018
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/29522090" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29522090</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data on prognostic factors of interest only presented for patients with deterioration; no comparative data for those without deterioration</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Durand
|
|
M. L., Calderwood
|
|
S. B., Weber
|
|
D. J., Miller
|
|
S. I., Southwick
|
|
F. S., Caviness
|
|
V. S.
|
|
Jr, Swartz
|
|
M. N., Acute bacterial meningitis in adults - A review of 493 episodes, New England Journal of Medicine, 328, 21–28, 1993
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/8416268" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8416268</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Paper does not identify risk factors for brain herniation</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ellis
|
|
Jayne, Luintel
|
|
Akish, Chandna
|
|
Arjun, Heyderman
|
|
Robert S., Community-acquired acute bacterial meningitis in adults: a clinical update, British medical bulletin, 131, 57–70, 2019
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/31556944" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31556944</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: description of clinical features and management guide</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Evans
|
|
R. W., Complications of lumbar puncture, Neurologic Clinics, 16, 83–105, 1998
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/9421542" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9421542</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: nonsystematic review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Glimaker
|
|
M., Johansson
|
|
B., Grindborg
|
|
O., Bottai
|
|
M., Lindquist
|
|
L., Sjolin
|
|
J., Adult bacterial meningitis: earlier treatment and improved outcome following guideline revision promoting prompt lumbar puncture, Clinical Infectious DiseasesClin Infect Dis, 60, 1162–9, 2015 [<a href="https://pubmed.ncbi.nlm.nih.gov/25663160" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25663160</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design and outcomes do not meet inclusion criteria: registry study with focus on timing of treatment</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Glimaker
|
|
M., Johansson
|
|
B., Halldorsdottir
|
|
H., Wanecek
|
|
M., Elmi-Terander
|
|
A., Ghatan
|
|
P. H., Lindquist
|
|
L., Bellander
|
|
B. M., Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study, Plos one, 9, 2014 [<a href="/pmc/articles/PMC3965390/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3965390</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24667767" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24667767</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparison or outcome of interest for this review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Grande
|
|
P. O., Myhre
|
|
E. B., Nordstrom
|
|
C. H., Schliamser
|
|
S., Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis, Acta Anaesthesiologica Scandinavica, 46, 264–70, 2002
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/11939916" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11939916</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No outcomes of interest for review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hasbun
|
|
R., Abrahams
|
|
J., Jekel
|
|
J., Quagliarello
|
|
V. J., Computed tomography of the head before lumbar puncture in adults with suspected meningitis, New England Journal of Medicine, 345, 1727–1733, 2001
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/11742046" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11742046</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No outcomes of interest for review. Study investigated Whether clinical features predict CT abnormalities</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Heckenberg
|
|
Sebastiaan G. B., de Gans
|
|
Jan, Brouwer
|
|
Matthijs C., Weisfelt
|
|
Martijn, Piet
|
|
Jurgen R., Spanjaard
|
|
Lodewijk, van der Ende
|
|
Arie, van de Beek
|
|
Diederik, Clinical features, outcome, and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective cohort study, Medicine, 87, 185–192, 2008
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/18626301" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18626301</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No outcomes of interest for review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Heyderman
|
|
R. S., Klein
|
|
N. J., Emergency management of meningitis, Journal of the Royal Society of Medicine, 93, 225–229, 2000
|
|
[<a href="/pmc/articles/PMC1297996/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1297996</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10884763" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10884763</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: nonsystematic review and management</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Joffe
|
|
Ari R., Lumbar puncture and brain herniation in acute bacterial meningitis: a review, Journal of intensive care medicine, 22, 194–207, 2007
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/17712055" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17712055</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review paper that includes population/review questions that are not relevant for the review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kellner
|
|
James D., Scheifele
|
|
David W., Halperin
|
|
Scott A., Lebel
|
|
Marc H., Moore
|
|
Dorothy, Le Saux
|
|
Nicolle, Ford-Jones
|
|
E. Lee, Law
|
|
Barbara, Vaudry
|
|
Wendy, Canadian Paediatric Society/Centre for Infectious Disease, Prevention, Control Immunization Monitoring, Program, Outcome of penicillin-nonsusceptible Streptococcus pneumoniae meningitis: a nested case-control study, The Pediatric infectious disease journal, 21, 903–10, 2002
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/12394810" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12394810</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No outcomes of interest for the review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Koelman
|
|
D., Brouwer
|
|
M. C., Ter Horst
|
|
L., Bijlsma
|
|
M., Van Der Ende
|
|
A., Van De Beek
|
|
D., Clinical characteristics, prognostic factors, and causes of death in adults with community-acquired pneumococcal meningitis, European Journal of Neurology, 27 (Supplement 1), 449, 2020
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference Abstract</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kwong
|
|
K. L., Chiu
|
|
W. K., Potential risk of fatal cerebral herniation after lumbar puncture in suspected CNS infection, Hong Kong Journal of Paediatrics, 14, 22–28, 2009
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: nonsystematic review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Mellor
|
|
D. H., The place of computed tomography and lumbar puncture in suspected bacterial meningitis, Archives of Disease in Childhood, 67, 1417–1419, 1992
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|
[<a href="/pmc/articles/PMC1793959/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1793959</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/1489216" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1489216</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: nonsystematic review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Meyer
|
|
C. N., Augustesen
|
|
S., Models of predicting the risk of brain herniation in bacterial meningitis, Clinical Microbiology and Infection, 15, S335–S336, 2009
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Meyer
|
|
C. N., Augustesen
|
|
S., Brain herniation and the use of CT-scanning in acute bacterial meningitis, Clinical microbiology and infection, 15 (S4), S336, 2009
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Oliver
|
|
W. J., Shope
|
|
T. C., Kuhns
|
|
L. R., Fatal lumbar puncture: fact versus fiction--an approach to a clinical dilemma, Pediatrics, 112, e174–6, 2003
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/12949308" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12949308</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: nonsystematic review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Petheram
|
|
K. R. C., Neurology on the acute take, Clinical Medicine, Journal of the Royal College of Physicians of London, 10, 148–150, 2010 [<a href="/pmc/articles/PMC4952087/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4952087</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20437986" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20437986</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study type not of interest for review: summary of a conference</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Pfister
|
|
H. W., Feiden
|
|
W., Einhaupl
|
|
K. M., Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study, Archives of Neurology, 50, 575–81, 1993
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/8503793" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8503793</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparison of interest for this review. No risk factors for brain herniation assessed</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Pingree
|
|
E. W., Kimia
|
|
A. A., Nigrovic
|
|
L. E., The effect of traumatic lumbar puncture on hospitalization rate for febrile infants 28 to 60 days of age, Academic emergency medicine, 22, 240–3, 2015
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/25640087" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25640087</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: nonsystematic review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Radetsky
|
|
M., Fulminant bacterial meningitis, Pediatric infectious disease journal, 33, 204–207, 2014
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/24413408" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24413408</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: nonsystematic review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Rennick
|
|
G., Shann
|
|
F., De Campo
|
|
J., Cerebral herniation during bacterial meningitis in children, British medical journal, 306, 953–955, 1993
|
|
[<a href="/pmc/articles/PMC1677428/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1677428</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/8490469" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8490469</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison not of interest for review: no comparison between presence/absence of factors in those that did and did not have brain herniation</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Sharew
|
|
A., Bodilsen
|
|
J., Hansen
|
|
B. R., Nielsen
|
|
H., Brandt
|
|
C. T., The cause of death in bacterial meningitis, BMC Infectious Diseases, 20, 182, 2020
|
|
[<a href="/pmc/articles/PMC7045616/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7045616</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32106821" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32106821</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population not relevant for this review: not clear how many patients had lumber puncture</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Swanson
|
|
D., Meningitis, Pediatrics in Review, 36, 514–524, 2015
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/26628732" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26628732</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study type not of relevance for this review: guidance on diagnosis and management of meningitis</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tubiana
|
|
S., Varon
|
|
E., Biron
|
|
C., Ploy
|
|
M. C., Mourvillier
|
|
B., Taha
|
|
M. K., et al
|
|
Community-
|
|
acquired bacterial meningitis in adults: in-hospital prognosis, long-term disability and determinants of outcome in a multicentre prospective cohort, Clinical Microbiology and Infection, 26, 1192–1200, 2020 [<a href="https://pubmed.ncbi.nlm.nih.gov/31927117" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31927117</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No outcomes of interest for review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Turner
|
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T., Risk of cerebral herniation due to lumbar puncture in children with suspected meningitis, 28, 2003
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest to this review: systematic review with no relevant research questions</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Van De Beek
|
|
D., De Gans
|
|
J., Tunkel
|
|
A. R., Wijdicks
|
|
E. F. M., Community-acquired bacterial meningitis in adults, New England Journal of Medicine, 354, 44–53, 2006
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/16394301" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16394301</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: nonsystematic review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Van De Beek
|
|
D., Drake
|
|
J. M., Tunkel
|
|
A. R., Nosocomial bacterial meningitis, New England journal of medicine, 362, 146–154+100, 2010
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/20071704" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20071704</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: nonsystematic review</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Weisfelt
|
|
M., Van De Beek
|
|
D., Spanjaard
|
|
L., Reitsma
|
|
J. B., De Gans
|
|
J., Community-acquired bacterial meningitis in older people, Journal of the American Geriatrics Society, 54, 1500–1507, 2006
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/17038066" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17038066</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparison of interest for this review: paper compares outcomes for people aged 60 or over versus people under 60 years old</td></tr><tr><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Williams
|
|
J., Lye
|
|
D. C. B., Umapathi
|
|
T., Diagnostic lumbar puncture: Minimizing complications, Internal Medicine Journal, 38, 587–591, 2008
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/18422562" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18422562</span></a>]
|
|
</td><td headers="hd_h_niceng240er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review with no relevant questions for the current review</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">CT: computed tomography; OECD: Organisation for Economic Co-operation and Development</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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