Prior to the revised Swedish lumbar puncture guideline, a CT scan was often performed prior to lumbar puncture when acute bacterial meningitis was suspected. Taking the time to perform a CT scan of the head before lumbar puncture delays treatment and results in an unfavorable outcome. The Swedish guidelines were amended to omit altered mental status as a contraindication for lumbar puncture without a previous CT scan. A retrospective review of the Swedish registry was conducted to evaluate patient outcomes after the guideline was revised.
Over 700 cases of community-acquired adult bacterial meningitis were reviewed. Foregoing a CT scan before lumbar puncture resulted in patients receiving treatment 1.6 hours sooner. By following the new guidelines, mortality was decreased from 11.7% to 6.9% and risk of neurological sequelae also decreased from 49% to 38%.
The amendment of the Swedish guidelines to remove impaired mental status as a contraindication for lumbar punctures without prior CT scan led to more favorable outcomes. International guidelines on lumbar puncture would do well to consider this revision.
Glimaker M, et al. Adult bacterial meningitis: earlier treatment and improved outcome following guideline revision promoting prompt lumbar puncture. Clinical Infect Dis. 2015 Apr 15; 60(8):1162-9