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Lumbar puncture in the management of adults with suspected bacterial meningitis--a survey of practice

Lumbar puncture in the management of adults with suspected bacterial meningitis--a survey of practice
Lumbar puncture in the management of adults with suspected bacterial meningitis--a survey of practice
OBJECTIVES: Assess the use of lumbar puncture (LP) in the management of suspected community acquired bacterial meningitis in adults.

METHODS:A questionnaire was sent to secondary care clinicians (excluding junior house officers) in general internal and emergency medicine at three acute NHS healthcare trusts in the south west of England. The questionnaire recorded the experience of the clinician and asked questions related to case scenarios representing common presentations of bacterial meningitis or meningococcal disease.

RESULTS:The response rate was 42% (108/260). Nearly all of the respondents (91%) reported regularly managing patients with suspected meningitis. Most respondents considered that (i) brain computerised tomography (CT) was necessary prior to undertaking LP (78%, 60/77), (ii) LP was a useful first line investigation in a patient with meningococcal shock.(80%, 84/105), (iii) LP could be performed safely in a man with a falling level of consciousness if the CT brain was normal (89/106, 84%). Early antibiotic administration was considered important, other management priorities such as oxygen therapy, volume resuscitation, and critical care involvement were not emphasised.

CONCLUSIONS:Reported clinical practice in the investigation and management of meningitis in adults is not in line with current published guidance. Efforts to target interventions that promote consensus in practice are needed.
bacterial meningitus, lumbar puncture, meningococcal disease, adults, diagnosis, management
0163-4453
315-319
Clark, Tristan
712ec18e-613c-45df-a013-c8a22834e14f
Duffell, Erika
613744ec-45ee-41cb-8a3d-01a421152ebb
Stuart, James M.
2935cefb-d324-401f-874f-b45516a93195
Heyderman, Robert S.
cd37d4bb-c0fc-4498-9d41-6dad70179661
Clark, Tristan
712ec18e-613c-45df-a013-c8a22834e14f
Duffell, Erika
613744ec-45ee-41cb-8a3d-01a421152ebb
Stuart, James M.
2935cefb-d324-401f-874f-b45516a93195
Heyderman, Robert S.
cd37d4bb-c0fc-4498-9d41-6dad70179661

Clark, Tristan, Duffell, Erika, Stuart, James M. and Heyderman, Robert S. (2006) Lumbar puncture in the management of adults with suspected bacterial meningitis--a survey of practice. Journal of Infection, 52 (5), 315-319. (doi:10.1016/j.jinf.2005.07.025). (PMID:16209888)

Record type: Article

Abstract

OBJECTIVES: Assess the use of lumbar puncture (LP) in the management of suspected community acquired bacterial meningitis in adults.

METHODS:A questionnaire was sent to secondary care clinicians (excluding junior house officers) in general internal and emergency medicine at three acute NHS healthcare trusts in the south west of England. The questionnaire recorded the experience of the clinician and asked questions related to case scenarios representing common presentations of bacterial meningitis or meningococcal disease.

RESULTS:The response rate was 42% (108/260). Nearly all of the respondents (91%) reported regularly managing patients with suspected meningitis. Most respondents considered that (i) brain computerised tomography (CT) was necessary prior to undertaking LP (78%, 60/77), (ii) LP was a useful first line investigation in a patient with meningococcal shock.(80%, 84/105), (iii) LP could be performed safely in a man with a falling level of consciousness if the CT brain was normal (89/106, 84%). Early antibiotic administration was considered important, other management priorities such as oxygen therapy, volume resuscitation, and critical care involvement were not emphasised.

CONCLUSIONS:Reported clinical practice in the investigation and management of meningitis in adults is not in line with current published guidance. Efforts to target interventions that promote consensus in practice are needed.

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More information

Accepted/In Press date: 23 July 2005
e-pub ahead of print date: 4 October 2005
Published date: May 2006
Keywords: bacterial meningitus, lumbar puncture, meningococcal disease, adults, diagnosis, management
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 386406
URI: http://eprints.soton.ac.uk/id/eprint/386406
ISSN: 0163-4453
PURE UUID: ee1d2929-4f2a-43f7-92c6-7445b934cb54
ORCID for Tristan Clark: ORCID iD orcid.org/0000-0001-6026-5295

Catalogue record

Date deposited: 01 Feb 2016 13:42
Last modified: 20 Jul 2019 00:37

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