512 lines
98 KiB
Text
512 lines
98 KiB
Text
<!DOCTYPE html>
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" class="no-js no-jr">
|
|
<head>
|
|
<!-- For pinger, set start time and add meta elements. -->
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books">
|
|
<meta name="ncbi_pdid" content="book-toc">
|
|
<meta name="ncbi_acc" content="NBK604145">
|
|
<meta name="ncbi_domain" content="niceng240er9">
|
|
<meta name="ncbi_report" content="reader">
|
|
<meta name="ncbi_type" content="fulltext">
|
|
<meta name="ncbi_objectid" content="">
|
|
<meta name="ncbi_pcid" content="/NBK604145/?report=reader">
|
|
<meta name="ncbi_pagename" content="Evidence review for role of neuroimaging prior to lumbar puncture - NCBI Bookshelf">
|
|
<meta name="ncbi_bookparttype" content="toc">
|
|
<meta name="ncbi_app" content="bookshelf">
|
|
<!-- Logger end -->
|
|
|
|
<!--component id="Page" label="meta"/-->
|
|
<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Evidence review for role of neuroimaging prior to lumbar puncture - NCBI Bookshelf</title>
|
|
<meta charset="utf-8">
|
|
<meta name="apple-mobile-web-app-capable" content="no">
|
|
<meta name="viewport" content="initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no">
|
|
<meta name="jr-col-layout" content="1">
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE,NOIMAGEINDEX">
|
|
<meta name="citation_title" content="Evidence review for role of neuroimaging prior to lumbar puncture">
|
|
<meta name="citation_publisher" content="National Institute for Health and Care Excellence (NICE)">
|
|
<meta name="citation_date" content="2024/03">
|
|
<meta name="citation_pmid" content="38838178">
|
|
<meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK604145/">
|
|
<meta name="citation_keywords" content="Meningitis, Bacterial">
|
|
<meta name="citation_keywords" content="Meningitis, Meningococcal">
|
|
<meta name="citation_keywords" content="Spinal Puncture">
|
|
<meta name="citation_keywords" content="Neuroimaging">
|
|
<meta name="citation_keywords" content="Cerebrospinal Fluid">
|
|
<meta name="citation_keywords" content="Diagnosis, Differential">
|
|
<meta name="citation_keywords" content="Diagnosis">
|
|
<meta name="citation_keywords" content="Infant">
|
|
<meta name="citation_keywords" content="Child, Preschool">
|
|
<meta name="citation_keywords" content="Child">
|
|
<meta name="citation_keywords" content="Adolescent">
|
|
<meta name="citation_keywords" content="Young Adult">
|
|
<meta name="citation_keywords" content="Adult">
|
|
<meta name="citation_keywords" content="Middle Aged">
|
|
<meta name="citation_keywords" content="Aged">
|
|
<meta name="citation_keywords" content="Aged, 80 and over">
|
|
<meta name="citation_keywords" content="Humans">
|
|
<meta name="citation_keywords" content="Review">
|
|
<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/">
|
|
<meta name="DC.Title" content="Evidence review for role of neuroimaging prior to lumbar puncture">
|
|
<meta name="DC.Type" content="Text">
|
|
<meta name="DC.Publisher" content="National Institute for Health and Care Excellence (NICE)">
|
|
<meta name="DC.Date" content="2024/03">
|
|
<meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK604145/">
|
|
<meta name="og:title" content="Evidence review for role of neuroimaging prior to lumbar puncture">
|
|
<meta name="og:type" content="book">
|
|
<meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK604145/">
|
|
<meta name="og:site_name" content="NCBI Bookshelf">
|
|
<meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng240er9-lrg.png">
|
|
<meta name="twitter:card" content="summary">
|
|
<meta name="twitter:site" content="@ncbibooks">
|
|
<meta name="bk-non-canon-loc" content="/books/n/niceng240er9/toc/?report=reader">
|
|
<link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK604145/">
|
|
<link href="https://fonts.googleapis.com/css?family=Archivo+Narrow:400,700,400italic,700italic&subset=latin" rel="stylesheet" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/libs.min.css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/jr.min.css">
|
|
<meta name="format-detection" content="telephone=no">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css//books_print.min.css" type="text/css" media="print">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_reader.min.css" type="text/css">
|
|
<style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style>
|
|
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico">
|
|
<meta name="ncbi_phid" content="CE8D80507D6B01D10000000000F400C9.m_5">
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3849091.css"></head>
|
|
<body>
|
|
<!-- Book content! -->
|
|
|
|
|
|
<div id="jr" data-jr-path="/corehtml/pmc/jatsreader/ptpmc_3.22/"><div class="jr-unsupported"><table class="modal"><tr><td><span class="attn inline-block"></span><br />Your browser does not support the NLM PubReader view.<br />Go to <a href="/pmc/about/pr-browsers/">this page</a> to see a list of supported browsers<br />or return to the <br /><a href="/books/NBK604145/?report=classic">regular view</a>.</td></tr></table></div><div id="jr-ui" class="hidden"><nav id="jr-head"><div class="flexh tb"><div id="jr-tb1"><a id="jr-links-sw" class="hidden" title="Links"><svg xmlns="http://www.w3.org/2000/svg" version="1.1" x="0px" y="0px" viewBox="0 0 70.6 85.3" style="enable-background:new 0 0 70.6 85.3;vertical-align:middle" xml:space="preserve" width="24" height="24">
|
|
<style type="text/css">.st0{fill:#939598;}</style>
|
|
<g>
|
|
<path class="st0" d="M36,0C12.8,2.2-22.4,14.6,19.6,32.5C40.7,41.4-30.6,14,35.9,9.8"></path>
|
|
<path class="st0" d="M34.5,85.3c23.2-2.2,58.4-14.6,16.4-32.5c-21.1-8.9,50.2,18.5-16.3,22.7"></path>
|
|
<path class="st0" d="M34.7,37.1c66.5-4.2-4.8-31.6,16.3-22.7c42.1,17.9,6.9,30.3-16.4,32.5h1.7c-66.2,4.4,4.8,31.6-16.3,22.7 c-42.1-17.9-6.9-30.3,16.4-32.5"></path>
|
|
</g>
|
|
</svg> Books</a></div><div class="jr-rhead f1 flexh"></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 c-11.235,4.66-23.919,4.333-34.905-0.889l-28.723-13.653l-39.234,39.234l13.653,28.721c5.219,10.979,5.545,23.681,0.889,34.91 c-0.002,0.004-0.004,0.009-0.006,0.013c-4.649,11.214-13.834,19.931-25.271,23.998L50,228.257v55.485l29.98,10.661 c11.431,4.065,20.627,12.794,25.274,24c0.002,0.005,0.003,0.01,0.005,0.014c4.66,11.236,4.334,23.921-0.888,34.906l-13.654,28.723 l39.234,39.234l28.721-13.652c10.979-5.219,23.681-5.546,34.909-0.889c0.005,0.002,0.01,0.004,0.014,0.006 c11.214,4.649,19.93,13.833,23.998,25.271L228.257,462h55.484l10.595-29.79c4.103-11.538,12.908-20.824,24.216-25.525 c0.005-0.002,0.009-0.004,0.014-0.006c11.127-4.628,23.694-4.311,34.578,0.863l28.902,13.738l39.234-39.234l-13.66-28.737 c-5.214-10.969-5.539-23.659-0.886-34.877c0.002-0.005,0.004-0.009,0.006-0.014c4.654-11.225,13.848-19.949,25.297-24.021 L462,283.742z M256,331.546c-41.724,0-75.548-33.823-75.548-75.546s33.824-75.547,75.548-75.547 c41.723,0,75.546,33.824,75.546,75.547S297.723,331.546,256,331.546z"></path></svg></a><a id="jr-fip-sw" class="btn wsprkl hidden" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-cmap-sw" class="btn wsprkl hidden" title="Table of Contents"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,20h10v8H20V20zM36,20h44v8H36V20zM20,37.33h10v8H20V37.33zM36,37.33h44v8H36V37.33zM20,54.66h10v8H20V54.66zM36,54.66h44v8H36V54.66zM20,72h10v8 H20V72zM36,72h44v8H36V72z"></path></svg></a></div></div></nav><nav id="jr-dash" class="noselect"><nav id="jr-dash" class="noselect"><div id="jr-pi" class="hidden"><a id="jr-pi-prev" class="hidden" title="Previous page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a><div class="pginfo">Page <i class="jr-pg-pn">0</i> of <i class="jr-pg-lp">0</i></div><a id="jr-pi-next" class="hidden" title="Next page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div><div id="jr-is-tb"><a id="jr-is-sw" class="btn wsprkl hidden" title="Switch between Figures/Tables strip and Progress bar"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><rect x="10" y="40" width="20" height="20"></rect><rect x="40" y="40" width="20" height="20"></rect><rect x="70" y="40" width="20" height="20"></rect></svg></a></div><nav id="jr-istrip" class="istrip hidden"><a id="jr-is-prev" href="#" class="hidden" title="Previous"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M80,40 60,65 80,90 70,90 50,65 70,40z M50,40 30,65 50,90 40,90 20,65 40,40z"></path><text x="35" y="25" textLength="60" style="font-size:25px">Prev</text></svg></a><a id="jr-is-next" href="#" class="hidden" title="Next"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,40 40,65 20,90 30,90 50,65 30,40z M50,40 70,65 50,90 60,90 80,65 60,40z"></path><text x="15" y="25" textLength="60" style="font-size:25px">Next</text></svg></a></nav><nav id="jr-progress"></nav></nav></nav><aside id="jr-links-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">NCBI Bookshelf</div></div><div class="cnt lol f1"><a href="/books/">Home</a><a href="/books/browse/">Browse All Titles</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://www.facebook.com/sharer/sharer.php?u=https://www.ncbi.nlm.nih.gov/books/NBK604145/"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24" preserveAspectRatio="none"><g><path d="M 17.996,32L 12,32 L 12,16 l-4,0 l0-5.514 l 4-0.002l-0.006-3.248C 11.993,2.737, 13.213,0, 18.512,0l 4.412,0 l0,5.515 l-2.757,0 c-2.063,0-2.163,0.77-2.163,2.209l-0.008,2.76l 4.959,0 l-0.585,5.514L 18,16L 17.996,32z"></path></g></svg> Share on Facebook</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://twitter.com/intent/tweet?url=https://www.ncbi.nlm.nih.gov/books/NBK604145/&text=Evidence%20review%20for%20role%20of%20neuroimaging%20prior%20to%20lumbar%20puncture"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24"><g><path d="M 32,6.076c-1.177,0.522-2.443,0.875-3.771,1.034c 1.355-0.813, 2.396-2.099, 2.887-3.632 c-1.269,0.752-2.674,1.299-4.169,1.593c-1.198-1.276-2.904-2.073-4.792-2.073c-3.626,0-6.565,2.939-6.565,6.565 c0,0.515, 0.058,1.016, 0.17,1.496c-5.456-0.274-10.294-2.888-13.532-6.86c-0.565,0.97-0.889,2.097-0.889,3.301 c0,2.278, 1.159,4.287, 2.921,5.465c-1.076-0.034-2.088-0.329-2.974-0.821c-0.001,0.027-0.001,0.055-0.001,0.083 c0,3.181, 2.263,5.834, 5.266,6.438c-0.551,0.15-1.131,0.23-1.73,0.23c-0.423,0-0.834-0.041-1.235-0.118 c 0.836,2.608, 3.26,4.506, 6.133,4.559c-2.247,1.761-5.078,2.81-8.154,2.81c-0.53,0-1.052-0.031-1.566-0.092 c 2.905,1.863, 6.356,2.95, 10.064,2.95c 12.076,0, 18.679-10.004, 18.679-18.68c0-0.285-0.006-0.568-0.019-0.849 C 30.007,8.548, 31.12,7.392, 32,6.076z"></path></g></svg> Share on Twitter</a></div></aside><aside id="jr-cmap-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">In Page Navigation</div></div><div class="cnt lol f1"><a href="/books/n/niceercollect/?report=reader">NICE Evidence Reviews Collection</a><a class="current">Title Information</a></div></aside><aside id="jr-help-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Settings</div></div><div class="cnt f1"><div id="jr-typo-p" class="typo"><div><a class="sf btn wsprkl">A-</a><a class="lf btn wsprkl">A+</a></div><div><a class="bcol-auto btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 200 100" preserveAspectRatio="none"><text x="10" y="70" style="font-size:60px;font-family: Trebuchet MS, ArialMT, Arial, sans-serif" textLength="180">AUTO</text></svg></a><a class="bcol-1 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M15,25 85,25zM15,40 85,40zM15,55 85,55zM15,70 85,70z"></path></svg></a><a class="bcol-2 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M5,25 45,25z M55,25 95,25zM5,40 45,40z M55,40 95,40zM5,55 45,55z M55,55 95,55zM5,70 45,70z M55,70 95,70z"></path></svg></a></div></div><div class="lol"><a class="" href="/books/NBK604145/?report=classic">Switch to classic view</a><a href="/books/n/niceng240er9/pdf/">PDF (668K)</a><a href="/books/n/niceng240er9/toc/?report=printable">Print View</a></div></div></aside><aside id="jr-bkhelp-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Help</div></div><div class="cnt f1 lol"><a id="jr-helpobj-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/help.xml" href="">Help</a><a href="mailto:info@ncbi.nlm.nih.gov?subject=PubReader%20feedback%20%2F%20NBK604145%20%2F%20sid%3ACE8B5AF87C7FFCB1_0191SID%20%2F%20phid%3ACE8D80507D6B01D10000000000F400C9.4">Send us feedback</a><a id="jr-about-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/about.xml" href="">About PubReader</a></div></aside><aside id="jr-objectbox" class="thidden hidden"><div class="jr-objectbox-close wsprkl">✘</div><div class="jr-objectbox-inner cnt"><div class="jr-objectbox-drawer"></div></div></aside><nav id="jr-pm-left" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Previous Page</text></svg></nav><nav id="jr-pm-right" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Next Page</text></svg></nav><nav id="jr-fip" class="hidden"><nav id="jr-fip-term-p"><input type="search" placeholder="search this page" id="jr-fip-term" autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng240er9-lrg.png" alt="Cover of Evidence review for role of neuroimaging prior to lumbar puncture" /></a></div><div class="bkr_bib"><h1 id="_NBK604145_"><span itemprop="name">Evidence review for role of neuroimaging prior to lumbar puncture</span></h1><div class="subtitle">Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management</div><p><b>Evidence review B5</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">978-1-4731-5759-0</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2024.</div></div><div class="bkr_clear"></div></div><div id="niceng240er9.s1"><h2 id="_niceng240er9_s1_">Role of neuroimaging prior to lumbar puncture</h2><div id="niceng240er9.s1.1"><h3>Review question</h3><p>What is the role of neuroimaging prior to lumbar puncture?</p><div id="niceng240er9.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>Neuroimaging is frequently performed prior to performing a lumbar puncture either to exclude other differential diagnoses or to assess for the presence of significantly raised intracranial pressure. However, obtaining neuroimaging in all cases of suspected bacterial meningitis delays performing a lumbar puncture and obtaining CSF for important diagnostic investigations. In turn, this may also delay effective treatment and management.</p><p>The aim of this review is to evaluate the role of neuroimaging prior to lumbar puncture when bacterial meningitis is suspected.</p></div><div id="niceng240er9.s1.1.2"><h4>Summary of the protocol</h4><p>See <a href="/books/NBK604145/table/niceng240er9.tab1/?report=objectonly" target="object" rid-ob="figobniceng240er9tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng240er9tab1"><a href="/books/NBK604145/table/niceng240er9.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img" rid-ob="figobniceng240er9tab1"><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="niceng240er9.tab1"><a href="/books/NBK604145/table/niceng240er9.tab1/?report=objectonly" target="object" rid-ob="figobniceng240er9tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO table). </p></div></div><p>For further details see the review protocol in <a href="#niceng240er9.appa">appendix A</a>.</p></div><div id="niceng240er9.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="#niceng240er9.appa">appendix A</a> and the <a href="/books/NBK604145/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="niceng240er9.s1.1.4"><h4>Effectiveness evidence</h4><div id="niceng240er9.s1.1.4.1"><h5>Included studies</h5><p>Three cohort studies were included for this review: 2 prospective cohort studies (<a class="bibr" href="#niceng240er9.ref2" rid="niceng240er9.ref2">Glimaker 2018</a>, <a class="bibr" href="#niceng240er9.ref3" rid="niceng240er9.ref3">Hasbun 2001</a>) and 1 retrospective cohort study (<a class="bibr" href="#niceng240er9.ref1" rid="niceng240er9.ref1">Glimaker 2015</a>). No relevant test and treat randomised controlled trials were identified.</p><p>The included studies are summarised in <a href="/books/NBK604145/table/niceng240er9.tab2/?report=objectonly" target="object" rid-ob="figobniceng240er9tab2">Table 2</a>.</p><p>All studies compared lumbar puncture without prior computerised tomography (CT) with lumbar puncture after CT in adults only. Only 1 study provided adjustment for confounding factors for relevant outcomes (<a class="bibr" href="#niceng240er9.ref2" rid="niceng240er9.ref2">Glimaker 2018</a>).</p><p>See the literature search strategy in <a href="#niceng240er9.appb">appendix B</a> and study selection flow chart in <a href="#niceng240er9.appc">appendix C</a>.</p></div><div id="niceng240er9.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="#niceng240er9.appj">appendix J</a>.</p></div></div><div id="niceng240er9.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/NBK604145/table/niceng240er9.tab2/?report=objectonly" target="object" rid-ob="figobniceng240er9tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng240er9tab2"><a href="/books/NBK604145/table/niceng240er9.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img" rid-ob="figobniceng240er9tab2"><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="niceng240er9.tab2"><a href="/books/NBK604145/table/niceng240er9.tab2/?report=objectonly" target="object" rid-ob="figobniceng240er9tab2">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="#niceng240er9.appd">appendix D</a>. No meta-analysis was conducted (and so there are no forest plots in <a href="#niceng240er9.appe">appendix E</a>).</p></div><div id="niceng240er9.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="#niceng240er9.appf">appendix F</a>. For details of the committee's confidence in the evidence and how this affected recommendations, see <a href="#niceng240er9.s1.1.10">The committee’s discussion and interpretation of the evidence</a>.</p><p>The evidence was assessed as being moderate to very low quality, most of the studies at very high risk of bias due to not adjusting analyses for confounding factors, seriously indirect due to a significant proportion of the population being immunosuppressed, and seriously imprecise findings. There was insufficient evidence to stratify by age or according to risk factors for brain herniation. See the GRADE tables in <a href="#niceng240er9.appf">appendix F</a> for the certainty of the evidence for each individual outcome.</p><p>Compared with lumbar puncture after CT, lumbar puncture without prior CT had lower rates of mortality, long term neurological impairment in the form of neurological and/or hearing deficits, time to antibiotic treatment (with or without corticosteroids) within 1 hour and within 2 hours, and a higher rate of people with no functional impairment, in adults with bacterial meningitis. However, there was no important difference observed in the evidence reviewed for long term neurological deficits in the form of cranial nerve palsy and arm/leg drift. The findings were seriously or very seriously imprecise for these outcomes, except for absence of functional impairment; therefore, they should not be taken as definitive evidence of association, or lack of association.</p><p>It was not possible to estimate the 95% confidence intervals for the mean difference on time to lumbar puncture and time to starting antibiotics in <a class="bibr" href="#niceng240er9.ref3" rid="niceng240er9.ref3">Hasbun 2001</a>, as standard deviations and the number of patients in each arm were not reported, respectively.</p><p>No studies reported data for the other outcomes in the protocol (brain herniation, severe developmental delay, or serious intervention-related adverse effects), and no evidence was available for babies and children.</p><p>See <a href="#niceng240er9.appf">appendix F</a> for full GRADE tables.</p></div><div id="niceng240er9.s1.1.7"><h4>Economic evidence</h4><div id="niceng240er9.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. See the literature search strategy in <a href="#niceng240er9.appb">appendix B</a> and economic study selection flow chart in <a href="#niceng240er9.appg">appendix G</a>.</p></div></div><div id="niceng240er9.s1.1.8"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because, although this question was originally prioritised, the clinical evidence although limited suggested that cost-effectiveness using the reviewed data would be self-evident and that original economic analysis would simply reinforce any recommendations made on the clinical evidence alone.</p></div><div id="niceng240er9.s1.1.9"><h4>Unit costs</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng240er9tab3"><a href="/books/NBK604145/table/niceng240er9.tab3/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobniceng240er9tab3"><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="niceng240er9.tab3"><a href="/books/NBK604145/table/niceng240er9.tab3/?report=objectonly" target="object" rid-ob="figobniceng240er9tab3">Table</a></h4></div></div></div><div id="niceng240er9.s1.1.10"><h4>The committee's discussion and interpretation of the evidence</h4><div id="niceng240er9.s1.1.10.1"><h5>The outcomes that matter most</h5><p>Brain herniation can occur following a lumbar puncture if there is raised intracranial pressure. As this is a potentially life-threatening complication, brain herniation and mortality were selected as critical outcomes due to the potential for neuroimaging to identify raised intracranial pressure and indirectly reduce the risk of brain herniation by impacting the decision to perform a lumbar puncture. Long-term neurological impairment was also prioritised as a critical outcome as it can be a complication of both brain herniation and meningitis itself.</p><p>Time between hospital admission and 1) lumbar puncture and 2) starting antibiotics were included as important outcomes due to concerns from the committee that the time required for neuroimaging can cause delays in both of these, which may have a detrimental effect on outcomes. As with long-term neurological impairment, functional impairment may be a complication of both brain herniation and meningitis itself, so it was selected as an important outcome in adults. However, severe developmental delay was included as an important outcome for children as this may be more commonly reported than neurological and functional impairment in trials of young children. Serious intervention-related adverse effects leading to death, disability or prolonged hospitalisation or that are life threatening or otherwise considered medically significant was also included as an important outcome to identify serious adverse effects other than brain herniation, for example, medically significant bleeding.</p></div><div id="niceng240er9.s1.1.10.2"><h5>The quality of the evidence</h5><p>The quality of the evidence was assessed with GRADE methodology and was rated as moderate quality for the absence of functional impairment outcome due to the population being indirect (including people who were immunocompromised), and low to very low quality for the remaining outcomes due to high risk of bias (arising from lack of adjustment for confounding factors), the population being indirect, and imprecision (due to wide confidence intervals and small number of events).</p><p>No evidence was found that reported on brain herniation, severe developmental delay or serious intervention-related adverse effects leading to death, disability or hospitalisation.</p></div><div id="niceng240er9.s1.1.10.3"><h5>Benefits and harms</h5><p>The committee considered the evidence comparing outcomes for people who underwent lumbar puncture without prior computerised tomography (CT) relative to those who underwent lumbar puncture with prior CT. Lumbar puncture without prior CT reduced mortality compared with lumbar puncture performed after neuroimaging. Lumbar puncture without prior CT was also associated with lower rates of neurological and/or hearing deficits and functional impairment, and a shorter time to antibiotic treatment (with or without corticosteroids), relative to lumbar puncture after CT. These findings were consistent with the clinical expertise of the committee, and they agreed that neuroimaging should not be routinely performed before lumbar puncture.</p><p>No evidence was identified for the critical outcome of brain herniation. Based on their clinical knowledge and experience, the committee recognised the potential for neuroimaging to identify raised intracranial pressure and indirectly reduce the risk of brain herniation by impacting the decision to perform a lumbar puncture. Based on evidence from the review on factors associated with brain herniation (see evidence review B4) and their knowledge and experience, the committee agreed that there are specific instances when imaging should be performed before lumbar puncture to mitigate the risk of brain herniation, namely when a person shows recognised signs of raised intracranial pressure (new focal neurological features, abnormal pupillary reactions, a Glasgow coma scale score of 9 or less, or a progressive and sustained or rapid fall in level of consciousness). The committee also agreed that imaging should be performed prior to lumbar puncture where the person has risk factors for an evolving space-occupying lesion. However, the committee discussed that neuroimaging should not cause a delay to management of bacterial meningitis and thus recommended that a blood sample should be taken, antibiotics should be started, and the person should be stabilised before imaging.</p></div><div id="niceng240er9.s1.1.10.4"><h5>Cost effectiveness and resource use</h5><p>No original economic analysis was undertaken for this review question and therefore the committee made a qualitative assessment of the likely cost-effectiveness of their recommendations.</p><p>The committee recognised that undertaking neuroimaging prior to lumbar puncture would increase costs by introducing a diagnostic investigation into the pathway which, as well as delaying optimal treatment for bacterial meningitis, would often provide little or no information that would improve subsequent management. Whilst the committee were aware that much of the evidence reviewed was of low quality, because of a high risk of bias, they did note that neuroimaging prior to lumbar puncture was associated with poorer outcomes having a significant impact on health-related quality of life. Therefore, the committee considered that it was reasonable to conclude that neuroimaging prior to LP was not cost-effective for people with suspected bacterial meningitis, where prompt appropriate antibiotics are critical to favourable outcomes.</p><p>Notwithstanding the limitations of the evidence, the committee were aware that their recommendations were consistent with other international guidance as well as recommendations made in previous NICE guidance. However, the committee noted that poor adherence with guidelines has been observed in the US, UK, the Netherlands, and Sweden (<a class="bibr" href="#niceng240er9.ref7" rid="niceng240er9.ref7">Salazar 2017</a>, <a class="bibr" href="#niceng240er9.ref6" rid="niceng240er9.ref6">Ellis 2022</a>, <a class="bibr" href="#niceng240er9.ref4" rid="niceng240er9.ref4">Costerus 2016</a>, <a class="bibr" href="#niceng240er9.ref2" rid="niceng240er9.ref2">Glimaker 2018</a>). A recent retrospective cohort study in the UK (<a class="bibr" href="#niceng240er9.ref6" rid="niceng240er9.ref6">Ellis 2022</a>) in a population with community acquired meningitis, found that neuroimaging prior to lumbar puncture occurred in 94% of patients, even though the majority of these (83%) had no contraindication to lumbar puncture. Less than 1% of patients had lumbar puncture within the first hour after arrival at hospital and only 26% had lumbar puncture within the first 8 hours. The study authors remarked that delays in obtaining CSF is associated with worse pathogen detection, more exposure to unnecessary anti-infectives, increased hospital length of stay and increased mortality. They concluded that “in most cases, brain imaging is not indicated in adults with suspected community-acquired meningitis; however, in our cohort, a significant number of patients had unnecessary scans. Although complications following LP are rare, there may be an unfounded fear of cerebral herniation following LP, even in those with no clinical features of brain shift, which is leading to excessive use of imaging.”</p><p>In addition to overcaution with respect to brain herniation, the committee also discussed other factors as to why compliance with guidelines might be poor. They noted that clinical assessment often takes place in a busy emergency department which they thought would not always be conducive to lumbar puncture and where there may be incentives in terms of patient workflow management from providing CT first, as that can facilitate faster patient outflows from the emergency department. The committee noted that the numbers presenting was also quite small which could limit the opportunities to learn from experience. The committee believed that logistically it was easier for LP to be performed quickly on a medical ward and that the time from admission to lumbar puncture would be improved if patients could be moved from the emergency department to an acute medical ward more quickly. The committee recognised that bed capacity could be a major implementation obstacle to this. The committee considered that the availability of LP kits could also be a limiting factor. Equipment shortages and lack of training were also factors picked up in a questionnaire (<a class="bibr" href="#niceng240er9.ref5" rid="niceng240er9.ref5">Defres 2015</a>) considering possible barriers to timely LP. The committee noted that generating requests for all the tests required on a cerebrospinal fluid sample is laborious, and that sometimes tests are inadvertently omitted. It was suggested that electronic order sets could improve practice in this regard.</p><p>The committee believed that their recommendations made it clearer that neuroimaging should not be routinely undertaken. Whilst the recommendations do not substantively change current guidance the committee recognised that current practice is varied and often suboptimal. The committee believed that widespread implementation of their recommendations has the potential to be cost saving to the NHS reducing unnecessary tests, ineffective treatments and hospital stay.</p></div></div><div id="niceng240er9.s1.1.11"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.4.6 to 1.4.8. Other evidence supporting the recommendations can be found in the evidence review on factors associated with brain herniation (see evidence review B4).</p></div></div><div id="niceng240er9.rl.r1"><h3>References - included studies</h3><ul class="simple-list"><div id="niceng240er9.rl.r1.1"><h4>Effectiveness</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng240er9.ref1"><p id="p-110">
|
|
<strong>Glimaker 2015</strong>
|
|
</p>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=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25663160</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng240er9.ref2"><p id="p-111">
|
|
<strong>Glimaker 2018</strong>
|
|
</p>Glimaker
|
|
M., Sjolin
|
|
J., Akesson
|
|
S., Naucler
|
|
P., Lumbar Puncture Performed Promptly or After Neuroimaging in Acute Bacterial Meningitis in Adults: A Prospective National Cohort Study Evaluating Different Guidelines, Clinical Infectious DiseasesClin Infect Dis, 66, 321–328, 2018 [<a href="https://pubmed.ncbi.nlm.nih.gov/29020334" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29020334</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng240er9.ref3"><p id="p-112">
|
|
<strong>Hasbun 2001</strong>
|
|
</p>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=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11742046</span></a>]</div></p></li></ul></div><div id="niceng240er9.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="niceng240er9.rl.r1.3"><h4>Other</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng240er9.ref4"><p id="p-114">
|
|
<strong>Costerus 2016</strong>
|
|
</p>Costerus
|
|
JM., Brouwer, MC., Bijlsma, MW., Tanck, MW., van der Ende, A., van de Beek, D. Impact of an evidence-based guideline on the management of community-acquired bacterial meningitis: a prospective cohort study. Clin Microbiol Infect
|
|
2016; 22:928–33.
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/27484018" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27484018</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng240er9.ref5"><p id="p-115">
|
|
<strong>Defres 2015</strong>
|
|
</p>Defres
|
|
S., Mayer
|
|
J., Backman
|
|
R., et al
|
|
Performing lumbar punctures for suspected CNS infections: experience and practice of trainee doctors. Br J Hosp Med
|
|
2015;76:658–62. [<a href="https://pubmed.ncbi.nlm.nih.gov/26551497" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26551497</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng240er9.ref6"><p id="p-116">
|
|
<strong>Ellis 2022</strong>
|
|
</p>Ellis
|
|
J., Harvey
|
|
D., Defres
|
|
S., et al
|
|
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
|
|
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><li class="half_rhythm"><p><div class="bk_ref" id="niceng240er9.ref7"><p id="p-117">
|
|
<strong>Salazar 2017</strong>
|
|
</p>Salazar
|
|
L., Hasbun
|
|
R,. Cranial imaging before lumbar puncture in adults with community-acquired meningitis: clinical utility and adherence to the Infectious Diseases Society of America guidelines. Clin Infect Dis
|
|
2017; 64:1657–62
|
|
[<a href="/pmc/articles/PMC5850549/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5850549</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28369295" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28369295</span></a>]</div></p></li></ul></div></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng240er9.appa"><h3>Appendix A. Review protocols</h3><p id="niceng240er9.appa.et1"><a href="/books/NBK604145/bin/niceng240er9-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: What is the role of neuroimaging prior to lumbar puncture?</a><span class="small"> (PDF, 250K)</span></p></div><div id="niceng240er9.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng240er9.appb.et1"><a href="/books/NBK604145/bin/niceng240er9-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review question: What is the role of neuroimaging prior to lumbar puncture?</a><span class="small"> (PDF, 243K)</span></p></div><div id="niceng240er9.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng240er9.appc.et1"><a href="/books/NBK604145/bin/niceng240er9-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for review question: What is the role of neuroimaging prior to lumbar puncture?</a><span class="small"> (PDF, 97K)</span></p></div><div id="niceng240er9.appd"><h3>Appendix D. Evidence tables</h3><p id="niceng240er9.appd.et1"><a href="/books/NBK604145/bin/niceng240er9-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: What is the role of neuroimaging prior to lumbar puncture?</a><span class="small"> (PDF, 209K)</span></p></div><div id="niceng240er9.appe"><h3>Appendix E. Forest plots</h3><div id="niceng240er9.appe.s1"><h4>Forest plots for review question: What is the role of neuroimaging prior to lumbar puncture?</h4><p>No meta-analysis was conducted for this review question and so there are no forest plots.</p></div></div><div id="niceng240er9.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng240er9.appf.et1"><a href="/books/NBK604145/bin/niceng240er9-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">GRADE tables for review question: What is the role of neuroimaging prior to lumbar puncture?</a><span class="small"> (PDF, 173K)</span></p></div><div id="niceng240er9.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng240er9.appg.et1"><a href="/books/NBK604145/bin/niceng240er9-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for review question: What is the role of neuroimaging prior to lumbar puncture?</a><span class="small"> (PDF, 98K)</span></p></div><div id="niceng240er9.apph"><h3>Appendix H. Economic evidence tables</h3><div id="niceng240er9.apph.s1"><h4>Economic evidence tables for review question: What is the role of neuroimaging prior to lumbar puncture?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="niceng240er9.appi"><h3>Appendix I. Economic model</h3><div id="niceng240er9.appi.s1"><h4>Economic model for review question: What is the role of neuroimaging prior to lumbar puncture?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="niceng240er9.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng240er9.appj.s1"><h4>Excluded studies for review question: What is the role of neuroimaging prior to lumbar puncture?</h4><div id="niceng240er9.appj.s1.1"><h5>Excluded effectiveness studies</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng240er9appjtab1"><a href="/books/NBK604145/table/niceng240er9.appj.tab1/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img" rid-ob="figobniceng240er9appjtab1"><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="niceng240er9.appj.tab1"><a href="/books/NBK604145/table/niceng240er9.appj.tab1/?report=objectonly" target="object" rid-ob="figobniceng240er9appjtab1">Table 6</a></h4><p class="float-caption no_bottom_margin">Excluded studies and reasons for their exclusion. </p></div></div></div><div id="niceng240er9.appj.s1.2"><h5>Excluded economic studies</h5><p>No economic evidence was identified for this review.</p></div></div></div><div id="niceng240er9.appk"><h3>Appendix K. Research recommendations – full details</h3><div id="niceng240er9.appk.s1"><h4>Research recommendations for review question: What is the role of neuroimaging prior to lumbar puncture?</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 recommendations 1.4.6 to 1.4.8 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: NBK604145</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/38838178" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">38838178</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng240er9tab1"><div id="niceng240er9.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604145/table/niceng240er9.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng240er9.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<b>Population</b>
|
|
</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</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<b>Intervention</b>
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lumbar puncture without prior neuroimaging</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;">Neuroimaging (CT or MRI) followed by lumbar puncture if appropriate (based on neuroimaging results)</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>
|
|
</p>
|
|
<p>Population: adults, infants and children<ul><li class="half_rhythm"><div>Brain herniation (may be reported as herniation, loss of pupillary reactivity, significant drop on Glasgow Coma Scale, coning)</div></li><li class="half_rhythm"><div>All-cause mortality (measured up to 1 year after discharge)</div></li><li class="half_rhythm"><div>Any long-term neurological impairment (defined as any motor deficits, sensory deficits, cognitive deficits*, or behavioural deficits*; measured from discharge up to 1 year after discharge)</div></li></ul></p>
|
|
<p>*For infants and children below school-age, cognitive and behavioural deficits will be assessed at school-age.</p>
|
|
<p>
|
|
<b>Important</b>
|
|
</p>
|
|
<p>Population: adults<ul><li class="half_rhythm"><div>Time between hospital admission and lumbar puncture</div></li><li class="half_rhythm"><div>Time between hospital admission and starting antibiotics</div></li><li class="half_rhythm"><div>Functional impairment (measured by any validated scale at any time point)</div></li><li class="half_rhythm"><div>Serious intervention-related adverse effects leading to death, disability or prolonged hospitalisation or that are life threatening or otherwise considered medically significant</div></li></ul></p>
|
|
<p>Population: infants and children<ul><li class="half_rhythm"><div>Time between hospital admission and lumbar puncture</div></li><li class="half_rhythm"><div>Time between hospital admission and starting antibiotics</div></li><li class="half_rhythm"><div>Severe developmental delay (defined as score of >2 SD below normal on validated assessment scales, or MDI or PDI <70 on Bayleys assessment scale, or inability to assign a score due to cerebral palsy or severity of cognitive delay; measured at the oldest age reported unless there is substantially more data available at a younger age)</div></li><li class="half_rhythm"><div>Serious intervention-related adverse effects leading to death, disability or prolonged hospitalisation or that are life threatening or otherwise considered medically significant</div></li></ul></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">CT: computerised tomography; MDI: mental development index; MRI: magnetic resonance imaging; PDI: psychomotor development index; SD: standard deviation</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng240er9tab2"><div id="niceng240er9.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/NBK604145/table/niceng240er9.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng240er9.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng240er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng240er9.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng240er9.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_niceng240er9.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><th id="hd_h_niceng240er9.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng240er9.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng240er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng240er9.ref1" rid="niceng240er9.ref1">Glimaker 2015</a>
|
|
</p>
|
|
<p>Retrospective cohort study</p>
|
|
<p>Sweden</p>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=712</p>
|
|
<p>Adults patients with acute community - acquired bacterial meningitis</p>
|
|
<p>Age, Median (range): 61 (17 to 95)</p>
|
|
<p>Patients with immunocompromised state: NR</p>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Lumbar puncture without prior CT</u>
|
|
</p>
|
|
<p>No further details reported</p>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Lumbar puncture with prior CT</u>
|
|
</p>
|
|
<p>No further details reported</p>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>All-cause mortality</div></li><li class="half_rhythm"><div>Any long-term neurological impairment (defined as neurological and/or hearing deficits)</div></li><li class="half_rhythm"><div>Time between hospital admission and starting antibiotics</div></li><li class="half_rhythm"><div>Absence of functional impairment (defined as recovery to normal activity without neurological or hearing deficits)</div></li></ul>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The study reported adjusting for confounding factors but did not report adjusted estimates for the relevant outcomes.</td></tr><tr><td headers="hd_h_niceng240er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng240er9.ref2" rid="niceng240er9.ref2">Glimaker 2018</a>
|
|
</p>
|
|
<p>Prospective cohort</p>
|
|
<p>Sweden</p>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=815</p>
|
|
<p>Adults (age >16 years) with acute bacterial meningitis</p>
|
|
<p>Age, Median (IQR): 62 (48 to 70)</p>
|
|
<p>Patients with immunocompromised state: 38%</p>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Lumbar puncture without prior CT</u>
|
|
</p>
|
|
<p>No further details reported</p>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Lumbar puncture with prior CT</u>
|
|
</p>
|
|
<p>No further details reported</p>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>All-cause mortality</div></li><li class="half_rhythm"><div>Any long-term neurological impairment (arm/leg drift; cranial nerve palsy)</div></li><li class="half_rhythm"><div>Time between hospital admission and starting antibiotics (adequate treatment with antibiotics and corticosteriods <1 hour; <2 hours)</div></li><li class="half_rhythm"><div>Absence of functional impairment (defined as GOS 5 and no neurological sequelae or hearing deficit)</div></li></ul>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confounding factors were adjusted for (sex, age, immunocompromised state, typical symptoms, mental status, new-onset seizures, cranial nerve palsy, septic shock, and causative organism) for outcomes, except for neurological deficit outcomes.</td></tr><tr><td headers="hd_h_niceng240er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng240er9.ref3" rid="niceng240er9.ref3">Hasbun 2001</a>
|
|
</p>
|
|
<p>Prospective Cohort study</p>
|
|
<p>USA</p>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=301</p>
|
|
<p>Adults >16 years with suspected meningitis</p>
|
|
<p>Age, Median (IQR), years: 40 (18 to 93)</p>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Lumbar puncture without prior CT</u>
|
|
</p>
|
|
<p>No further details reported</p>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>Lumbar puncture with prior CT</u>
|
|
</p>
|
|
<p>No further details reported</p>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Time between hospital admission and lumbar puncture</div></li><li class="half_rhythm"><div>Time between hospital admission and starting antibiotics</div></li></ul>
|
|
</td><td headers="hd_h_niceng240er9.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No adjustment for confounding factors</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: computerised tomography; GOS: Glasgow outcome scale; IQR: interquartile range</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng240er9tab3"><div id="niceng240er9.tab3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604145/table/niceng240er9.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng240er9.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng240er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Resource</th><th id="hd_h_niceng240er9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Unit costs</th><th id="hd_h_niceng240er9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Source</th></tr></thead><tbody><tr><td headers="hd_h_niceng240er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Computerised Tomography Scan of One Area, without Contrast, 19 years and over</td><td headers="hd_h_niceng240er9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£99</td><td headers="hd_h_niceng240er9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">National Schedule of NHS Costs 2020–21 <sup>1</sup></td></tr><tr><td headers="hd_h_niceng240er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Computerised Tomography Scan of One Area, without Contrast, between 6 and 18 years</td><td headers="hd_h_niceng240er9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£198</td><td headers="hd_h_niceng240er9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">National Schedule of NHS Costs 2020–21 <sup>2</sup></td></tr><tr><td headers="hd_h_niceng240er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Computerised Tomography Scan of One Area, without Contrast, 5 years and under</td><td headers="hd_h_niceng240er9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£92</td><td headers="hd_h_niceng240er9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">National Schedule of NHS Costs 2020–21 <sup>3</sup></td></tr><tr><td headers="hd_h_niceng240er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic Resonance Imaging Scan of One Area, without Contrast, 19 years and over</td><td headers="hd_h_niceng240er9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£176</td><td headers="hd_h_niceng240er9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">National Schedule of NHS Costs 2020–21 <sup>4</sup></td></tr><tr><td headers="hd_h_niceng240er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic Resonance Imaging Scan of One Area, without Contrast, between 6 and 18 years</td><td headers="hd_h_niceng240er9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£272</td><td headers="hd_h_niceng240er9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">National Schedule of NHS Costs 2020–21 <sup>5</sup></td></tr><tr><td headers="hd_h_niceng240er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic Resonance Imaging Scan of One Area, without Contrast, 5 years and under</td><td headers="hd_h_niceng240er9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£281</td><td headers="hd_h_niceng240er9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">National Schedule of NHS Costs 2020–21 <sup>6</sup></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng240er9.tab3_1"><p class="no_margin">Currency code RD20A</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng240er9.tab3_2"><p class="no_margin">Currency code RD20B</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng240er9.tab3_3"><p class="no_margin">Currency code RD20C</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="niceng240er9.tab3_4"><p class="no_margin">Currency code RD01A</p></div></dd></dl><dl class="bkr_refwrap"><dt>5</dt><dd><div id="niceng240er9.tab3_5"><p class="no_margin">Currency code RD01B</p></div></dd></dl><dl class="bkr_refwrap"><dt>6</dt><dd><div id="niceng240er9.tab3_6"><p class="no_margin">Currency code RD01C</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng240er9appjtab1"><div id="niceng240er9.appj.tab1" class="table"><h3><span class="label">Table 6</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/NBK604145/table/niceng240er9.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng240er9.appj.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng240er9.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_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Allen
|
|
D. M., Computed tomography in suspected bacterial meningitis, Singapore Medical JournalSingapore Med J, 31, 196–197, 1990 [<a href="https://pubmed.ncbi.nlm.nih.gov/2392693" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2392693</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest: narrative review</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Anonymous,, To CT or not to CT before LP in the ED?, Hospital Practice, 35, 124, 2000
|
|
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Participants not relevant to this review.</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
April
|
|
M. D., Long
|
|
B., Koyfman
|
|
A., Emergency Medicine Myths: Computed Tomography of the Head Prior to Lumbar Puncture in Adults with Suspected Bacterial Meningitis - Due Diligence or Antiquated Practice?, Journal of Emergency MedicineJ Emerg Med, 53, 313–321, 2017
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/28666562" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28666562</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Content of systematic review not relevant for this review question: most included studies did not report the comparison of interest. Of the two relevant included studies, one is already included in this review (Hasburn 2001) and the other only included participants who had CT.</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Archer
|
|
B. D., Computed tomography before lumbar puncture in acute meningitis: a review of the risks and benefits, CMAJ Canadian Medical Association JournalCmaj, 148, 961–5, 1993 [<a href="/pmc/articles/PMC1490723/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1490723</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/8448711" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8448711</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant comparison for this review: no evidence presented comparing those who had lumbar puncture without prior neuroimaging and those who had neuroimaging followed by lumbar puncture if appropriate.</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Aronin
|
|
S. I., Peduzzi
|
|
P., Quagliarello
|
|
V. J., Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing, Annals of Internal Medicine, 129, 862–9, 1998
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/9867727" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9867727</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparison of interest: study does not compare people who did nor did not have imaging.</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Arroliga
|
|
A. C., Intensive care update: seven studies that should change your practice, Cleveland Clinic Journal of MedicineCleve Clin J Med, 69, 505–9, 2002 [<a href="https://pubmed.ncbi.nlm.nih.gov/12061466" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12061466</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bhimraj
|
|
A., Acute community-acquired bacterial meningitis in adults: an evidence-based review, Cleveland Clinic Journal of MedicineCleve Clin J Med, 79, 393–400, 2012 [<a href="https://pubmed.ncbi.nlm.nih.gov/22660870" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22660870</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest: narrative review</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bryan
|
|
C. S., Reynolds
|
|
K. L., Crout
|
|
L., Promptness of antibiotic therapy in acute bacterial meningitis, Annals of Emergency Medicine, 15, 544–547, 1986
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/3963534" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3963534</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparator of interest for review: no data presented to compare people who did or did not have imaging.</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bushore
|
|
M., Marante
|
|
A. A., Emergency Department stabilization of pediatric patients with bacterial meningitis: Current advances, Emergency Medicine Clinics of North America, 9, 239–250, 1991
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/1893892" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1893892</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Chadwick
|
|
D. R., Lever
|
|
A. M., The impact of new diagnostic methodologies in the management of meningitis in adults at a teaching hospital, QjmQjm, 95, 663–70, 2002 [<a href="https://pubmed.ncbi.nlm.nih.gov/12324638" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12324638</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparative data between neuroimaging prior to lumbar puncture versus no imaging prior to lumbar puncture.</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Chaudhuri
|
|
A., Martin
|
|
P. M., Kennedy
|
|
P. G. E., Andrew Seaton
|
|
R., Portegies
|
|
P., Bojar
|
|
M., Steiner
|
|
I., EFNS guideline on the management of community-acquired bacterial meningitis: Report of an EFNS Task Force on acute bacterial meningitis in older children and adults, European journal of neurology, 15, 649–659, 2008
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/18582342" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18582342</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study questions not of interest for this review: no data presented to assess brain imaging.</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Choi
|
|
C., Bacterial meningitis in the elderly patient: Ten questions to consider, Infectious Diseases in Clinical Practice, 9, 17–22, 2000
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Costerus
|
|
J. M., Brouwer
|
|
M. C., Bijlsma
|
|
M. W., Tanck
|
|
M. W., van der Ende
|
|
A., van de Beek
|
|
D., Impact of an evidence-based guideline on the management of community-acquired bacterial meningitis: a prospective cohort study, Clinical Microbiology & InfectionClin Microbiol Infect, 22, 928–933, 2016 [<a href="https://pubmed.ncbi.nlm.nih.gov/27484018" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27484018</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: comparison between pre- and post-guideline practice.</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Costerus
|
|
J. M., Brouwer
|
|
M. C., Bijlsma
|
|
M. W., van de Beek
|
|
D., Community-acquired bacterial meningitis, Current Opinion in Infectious DiseasesCurr Opin Infect Dis, 30, 135–141, 2017 [<a href="https://pubmed.ncbi.nlm.nih.gov/27828810" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27828810</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Costerus
|
|
J. M., Brouwer
|
|
M. C., Sprengers
|
|
M. E. S., Roosendaal
|
|
S. D., van der Ende
|
|
A., van de Beek
|
|
D., Cranial Computed Tomography, Lumbar Puncture, and Clinical Deterioration in Bacterial Meningitis: A Nationwide Cohort Study, Clinical infectious diseases, 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_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant comparison for this review: 43/47 study participants and all matched controls had CT scans.</td></tr><tr><td headers="hd_h_niceng240er9.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_niceng240er9.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_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Dyckhoff-Shen
|
|
S., Koedel
|
|
U., Pfister
|
|
H. W., Klein
|
|
M., SOP: emergency workup in patients with suspected acute bacterial meningitis, Neurological Research and Practice, 3, 2, 2021
|
|
[<a href="/pmc/articles/PMC7791806/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7791806</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33499920" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33499920</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
El Bashir
|
|
H., Laundy
|
|
M., Booy
|
|
R., Diagnosis and treatment of bacterial meningitis, Archives of Disease in Childhood, 88, 615–620, 2003
|
|
[<a href="/pmc/articles/PMC1763168/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1763168</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/12818910" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12818910</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fitch
|
|
M. T., Abrahamian
|
|
F. M., Moran
|
|
G. J., Talan
|
|
D. A., Emergency department management of meningitis and encephalitis, Infectious Disease Clinics of North America, 22, 33–52, v-vi, 2008
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/18295682" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18295682</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Glimaker
|
|
M., Johansson
|
|
B., Bell
|
|
M., Ericsson
|
|
M., Blackberg
|
|
J., Brink
|
|
M., Lindquist
|
|
L., Sjolin
|
|
J., Early lumbar puncture in adult bacterial meningitis--rationale for revised guidelines, Scandinavian Journal of Infectious DiseasesScand J Infect Dis, 45, 657–63, 2013 [<a href="https://pubmed.ncbi.nlm.nih.gov/23808722" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23808722</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gopal
|
|
A. K., Whitehouse
|
|
J. D., Simel
|
|
D. L., Corey
|
|
G. R., Cranial computed tomography before lumbar puncture: A prospective clinical evaluation, Archives of Internal Medicine, 159, 2681–2685, 1999
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/10597758" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10597758</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Participants does not match protocol criteria: patients with meningitis was <50% of total participants included</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hasbun
|
|
R., Update and advances in community acquired bacterial meningitis, Current Opinion in Infectious DiseasesCurr Opin Infect Dis, 32, 233–238, 2019 [<a href="https://pubmed.ncbi.nlm.nih.gov/31021955" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31021955</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Haslam
|
|
R. H., Role of computed tomography in the early management of bacterial meningitis, The Journal of pediatrics, 119, 157–9, 1991
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/2066848" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2066848</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Heckenberg
|
|
S. G. B., De Gans
|
|
J., Brouwer
|
|
M. C., Weisfelt
|
|
M., Piet
|
|
J. R., Spanjaard
|
|
L., Van Der Ende
|
|
A., Van De Beek
|
|
D., 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_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant comparative data reported</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Heyderman
|
|
R. S., Lambert
|
|
H. P., O'Sullivan
|
|
I., Stuart
|
|
J. M., Taylor
|
|
B. L., Wall
|
|
R. A., Early management of suspected bacterial meningitis and meningococcal septicaemia in adults, Journal of infection, 46, 75–77, 2003
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/12634067" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12634067</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Heyderman
|
|
R. S., Robb
|
|
S. A., Kendall
|
|
B. E., Levin
|
|
M., Does computed tomography have a role in the evaluation of complicated acute bacterial meningitis in childhood?, 34, 870–5, 1992 [<a href="https://pubmed.ncbi.nlm.nih.gov/1356862" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1356862</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparison of interest: study did not provide data on CT versus no CT</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Imtiaz
|
|
A., Toomath
|
|
R., Computed tomography head scans prior to lumbar punctures in suspected meningitis, Internal Medicine Journal, 49, 55–58, 2019
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/29869434" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29869434</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparative data presented for people who did not undergo CT.</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Joffe
|
|
A. R., Lumbar puncture and brain herniation in acute bacterial meningitis: a review, Journal of Intensive Care MedicineJ Intensive Care Med, 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_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest: narrative review with no studies relevant to this review.</td></tr><tr><td headers="hd_h_niceng240er9.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_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design does not meet inclusion criteria: narrative review</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
McGill
|
|
F., Heyderman
|
|
R. S., Michael
|
|
B. D., Defres
|
|
S., Beeching
|
|
N. J., Borrow
|
|
R., Glennie
|
|
L., Gaillemin
|
|
O., Wyncoll
|
|
D., Kaczmarski
|
|
E., Nadel
|
|
S., Thwaites
|
|
G., Cohen
|
|
J., Davies
|
|
N. W., Miller
|
|
A., Rhodes
|
|
A., Read
|
|
R. C., Solomon
|
|
T., The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults, Journal of InfectionJ Infect, 72, 405–38, 2016
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/26845731" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26845731</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication type not relevant for this review: guideline</td></tr><tr><td headers="hd_h_niceng240er9.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
|
|
[<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_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest: narrative commentary.</td></tr><tr><td headers="hd_h_niceng240er9.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_niceng240er9.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_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Mirrakhimov
|
|
A. E., Gray
|
|
A., Ayach
|
|
T., When should brain imaging precede lumbar puncture in cases of suspected bacterial meningitis?, Cleveland Clinic journal of medicine, 84, 111113, 2017
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/28198685" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28198685</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nagra
|
|
I., Wee
|
|
B., Short
|
|
J., Banerjee
|
|
A. K., The role of cranial CT in the investigation of meningitis, JRSM Short ReportsJRSM Short Rep, 2, 20, 2011 [<a href="/pmc/articles/PMC3086327/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3086327</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21541088" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21541088</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparative data presented for people who did not have CT scans. No outcomes of interest presented.</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Oliveira
|
|
C. R., Morriss
|
|
M. C., Mistrot
|
|
J. G., Cantey
|
|
J. B., Doern
|
|
C. D., Sánchez
|
|
P. J., Brain magnetic resonance imaging of infants with bacterial meningitis, 165, 134–9, 2014 [<a href="/pmc/articles/PMC6855593/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6855593</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24726712" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24726712</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparison of interest: study did not provide information on lumbar puncture</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ostergaard
|
|
C., Konradsen
|
|
H.B., Samuelsson
|
|
S., Clinical presentation and prognostic factors of Streptococcus pneumoniae meningitis according to the focus of infection, BMC Infectious Diseases, 5, 93-, 2005
|
|
[<a href="/pmc/articles/PMC1295586/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1295586</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16253143" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16253143</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison not of interest for review: survivors vs non survivors</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Park
|
|
N., Hasbun
|
|
R., Comparison of four recommendations guiding the use of neuroimaging in the management of bacterial meningitis, Open Forum Infectious Diseases, 6 (Supplement 2), S507, 2019
|
|
</td><td headers="hd_h_niceng240er9.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_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Proulx
|
|
N., Frechette
|
|
D., Toye
|
|
B., Chan
|
|
J., Kravcik
|
|
S., Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis, QJM - Monthly Journal of the Association of Physicians, 98, 291–298, 2005
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/15760921" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15760921</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison not of interest for review: survivors vs non survivors</td></tr><tr><td headers="hd_h_niceng240er9.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_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparative data between neuroimaging prior to lumbar puncture versus no neuroimaging prior to lumbar puncture.</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Riordan
|
|
F. A. I., Cant
|
|
A. J., When to do a lumbar puncture, Archives of disease in childhood, 87, 235–237, 2002
|
|
[<a href="/pmc/articles/PMC1719243/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1719243</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/12193440" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12193440</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest: narrative commentary focussed on indications/contraindications for lumbar puncture</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Salazar
|
|
L., Hasbun
|
|
R., Cranial Imaging Before Lumbar Puncture in Adults With Community-Acquired Meningitis: Clinical Utility and Adherence to the Infectious Diseases Society of America Guidelines, Clinical Infectious DiseasesClin Infect Dis, 64, 1657–1662, 2017 [<a href="/pmc/articles/PMC5850549/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5850549</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28369295" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28369295</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison not of interest for review: in the CT not indicated arm, 87.3% of the population received CT</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Schuh
|
|
S., Lindner
|
|
G., Exadaktylos
|
|
A. K., Muhlemann
|
|
K., Tauber
|
|
M. G., Determinants of timely management of acute bacterial meningitis in the ED, American journal of emergency medicine, 31, 1056–1061, 2013
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/23702055" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23702055</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant comparison for review: study does not report outcomes for people who did or did not have neuroimaging</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Stockdale
|
|
A. J., Weekes
|
|
M. P., Aliyu
|
|
S. H., An audit of acute bacterial meningitis in a large teaching hospital 2005–10, QjmQjm, 104, 1055–63, 2011 [<a href="https://pubmed.ncbi.nlm.nih.gov/21840886" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21840886</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: noncomparative study (audit)</td></tr><tr><td headers="hd_h_niceng240er9.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_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study type not of interest for this review: commentary</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Turner
|
|
T., Risk of cerebral herniation due to lumbar puncture in children with suspected meningitis, 28, 2003
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparison of interest for this review</td></tr><tr><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Wall
|
|
E. C., Chan
|
|
J. M., Gil
|
|
E., Heyderman
|
|
R. S., Acute bacterial meningitis, Current Opinion in Neurology, 26, 26, 2021 [<a href="/pmc/articles/PMC7610733/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7610733</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33767093" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33767093</span></a>]
|
|
</td><td headers="hd_h_niceng240er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design not of interest for review: narrative commentary</td></tr></tbody></table></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>
|
|
|
|
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal106 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3968615.js" snapshot="books"></script></body>
|
|
</html>
|