Cranial computed tomographic scans have little impact on management of bacterial meningitis
I. R. Friedland, M. M. Paris, S. Rinderknecht and G. H. McCracken Jr
Department of Pediatrics, University of Texas Southwestern Medical School, Dallas.
OBJECTIVE--To assess which clinical features predict an increased
likelihood of an abnormal computed tomographic (CT) scan and how frequently
CT influences management of bacterial meningitis. DESIGN--Retrospective
patient series. SETTING--University-affiliated hospitals in Dallas, Tex.
PATIENTS--Three hundred thirty-seven children with bacterial meningitis, of
whom 107 (32%) had undergone CT scans. RESULTS--One or more abnormalities
were found in 52% of the initial scans. The most frequent indication for CT
at our institution was persistent or secondary fever, and in 56% of these
children, subdural effusion or empyema was noted. However, findings on CT
rarely predicted a need for intervention. In contrast, children with focal
seizures or focal neurologic signs were more likely to have brain
parenchymal changes. Scans in 19 patients (12%) prompted surgical
intervention, most commonly drainage of a subdural collection. The
conditions of only nine children (8.4% of those who had undergone CT scans)
improved following intervention that was initiated because of findings on
CT. CONCLUSIONS--Although CT scans are frequently abnormal in children with
meningitis, CT seldom reveals findings that require specific intervention.
