Cranial computed tomography, lumbar puncture, and clinical deterioration in bacterial meningitis: a nationwide cohort study
Open accessAbstract
Background: It is unclear how often lumbar puncture (LP) is complicated by cerebral herniation in patients with bacterial meningitis and whether cranial computed tomography (CT) can be used to identify patients at risk for herniation. Methods: We performed a nationwide prospective cohort study of patients with community-acquired bacterial meningitis from 2006 to 2014 and identified patients with clinical deterioration possibly caused by LP. For systematic evaluation of contraindications for LP on cranial CT, these patients were matched to patients in the cohort without deterioration. Four experts, blinded for outcome, scored cranial CT results for contraindications for LP. A Fleiss' generalized κ for this assessment was determined. Results: Of 1533 episodes, 47 (3.1%) had deterioration possibly caused by LP. Two patients deteriorated within 1 hour after LP (0.1%). In 43 of 47 patients with deterioration, cranial CT was performed prior to LP, so CT results were matched with 43 patients without deterioration. The interrater reliability of assessment of contraindications for LP on cranial CT was moderate (Fleiss' generalized κ = 0.47). A contraindication for LP was reported by all 4 raters in 6 patients with deterioration (14%) and in 5 without deterioration (11%). Conclusions: LP can be performed safely in the large majority of patients with bacterial meningitis, as it is only very rarely complicated by cerebral herniation. Cranial CT can be considered a screening method for contraindications for LP, but the interrater reliability of this assessment is moderate.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The text we found for this paper looks like another document, so the self-check wasn’t run.
Cites
Practice Guidelines for the Management of Bacterial Meningitis
Tunkel, A. R., Hartman, B. J., Kaplan, S. L., Kaufman, B. A., Roos, K. L., Scheld, W. M., & Whitley, R. J. (2004) · Clinical Infectious Diseases · doi:10.1086/425368 · Cited by 2,308 · see citing works
Clinical features and prognostic factors in adults with bacterial meningitis
van de Beek, D., de Gans, J., Spanjaard, L., Weisfelt, M., Reitsma, J. B., & Vermeulen, M. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa040845 · Cited by 1,639 · see citing works
Self-citationAcute Bacterial Meningitis in Adults -- A Review of 493 Episodes
Durand, M. L., Calderwood, S. B., Weber, D. J., Miller, S. I., Southwick, F. S., Caviness, V. S., & Swartz, M. N. (1993) · New England Journal of Medicine · doi:10.1056/nejm199301073280104 · Cited by 1,344 · see citing works
Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis
Brouwer, M. C., Tunkel, A. R., & van de Beek, D. (2010) · Clinical Microbiology Reviews · doi:10.1128/cmr.00070-09 · Cited by 930 · see citing works
Self-citationESCMID guideline: diagnosis and treatment of acute bacterial meningitis
van de Beek, D., Cabellos, C., Dzupova, O., Esposito, S., Klein, M., Kloek, A. T., Leib, S. L., Mourvillier, B., Ostergaard, C., Pagliano, P., et al. (2016) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2016.01.007 · Cited by 919 · see citing works
Self-citationCommunity-Acquired Bacterial Meningitis in Adults
van de Beek, D., de Gans, J., Tunkel, A. R., & Wijdicks, E. F. M. (2006) · New England Journal of Medicine · doi:10.1056/nejmra052116 · Cited by 871 · see citing works
PREDICTING OUTCOME IN INDIVIDUAL PATIENTS AFTER SEVERE HEAD INJURY
Jennett, B., Teasdale, G. M., Braakman, R., Minderhoud, J. M., & Knill-Jones, R. P. (1976) · The Lancet · doi:10.1016/s0140-6736(76)92215-7 · Cited by 781 · see citing works
Aronin, S. I., Peduzzi, P., & Quagliarello, V. J. (1998) · Annals of Internal Medicine · doi:10.7326/0003-4819-129-11_part_1-199812010-00004 · Cited by 486 · see citing works
Computed tomography of the head before lumbar puncture in adults with suspected meningitis
Hasbun, R., Abrahams, J., Jekel, J., & Quagliarello, V. J. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa010399 · Cited by 462 · see citing works
Proulx, N., Frechette, D., Toye, B., Chan, J., & Kravcik, S. (2005) · QJM · doi:10.1093/qjmed/hci047 · Cited by 454 · see citing works
Differential Diagnosis of Acute Meningitis
Spanos, A. (1989) · JAMA · doi:10.1001/jama.262.19.2700 · Cited by 436 · see citing works
Bijlsma, M. W., Brouwer, M. C., Kasanmoentalib, E. S., Kloek, A. T., Lucas, M. J., Tanck, M. W., van der Ende, A., & van de Beek, D. (2016) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(15)00430-2 · Cited by 412 · see citing works
Self-citationAdvances in treatment of bacterial meningitis
van de Beek, D., Brouwer, M. C., Thwaites, G. E., & Tunkel, A. R. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61186-6 · Cited by 337 · see citing works
Self-citationCommunity-acquired bacterial meningitis
van de Beek, D., Brouwer, M. C., Hasbun, R., Koedel, U., Whitney, C. G., & Wijdicks, E. F. M. (2016) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2016.74 · Cited by 314 · see citing works
Self-citationDilemmas in the diagnosis of acute community-acquired bacterial meningitis
Brouwer, M. C., Thwaites, G. E., Tunkel, A. R., & van de Beek, D. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61185-4 · Cited by 302 · see citing works
Self-citationCerebral herniation during bacterial meningitis in children.
Rennick, G. J., Shann, F., & de Campo, J. (1993) · BMJ · doi:10.1136/bmj.306.6883.953 · Cited by 192 · see citing works
Emergency diagnosis and treatment of adult meningitis
Fitch, M. T., & van de Beek, D. (2007) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(07)70050-6 · Cited by 189 · see citing works
Self-citationGlimåker, M., Johansson, B., Grindborg, Ö., Bottai, M., Lindquist, L., & Sjölin, J. (2015) · Clinical Infectious Diseases · doi:10.1093/cid/civ011 · Cited by 187 · see citing works
Lumbar Puncture and Brain Herniation in Acute Bacterial Meningitis: A Review
Joffe, A. R. (2007) · Journal of Intensive Care Medicine · doi:10.1177/0885066607299516 · Cited by 154 · see citing works
Cerebral herniation in bacterial meningitis in childhood
Horwitz, S. J., Boxerbaum, B., & O’Bell, J. (1980) · Annals of Neurology · doi:10.1002/ana.410070605 · Cited by 137 · see citing works
Lumbar Puncture in the Presence of Raised Intracranial Pressure
Duffy, G. P. (1969) · BMJ · doi:10.1136/bmj.1.5641.407 · Cited by 115 · see citing works
Progress and challenges in bacterial meningitis
van de Beek, D. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61808-x · Cited by 92 · see citing works
Wylie, P., Stevens, D., Drake, W., Stuart, J., & Cartwright, K. A. V. (1997) · BMJ · doi:10.1136/bmj.315.7111.774 · Cited by 79 · see citing works
Winkler, F., Kastenbauer, S., Yousry, T. A., et al. (2002) · Journal of Neurology · doi:10.1007/s00415-002-0844-8 · Cited by 67 · see citing works
Community-Acquired Bacterial Meningitis
Abrahamian, F. M., Moran, G. J., & Talan, D. (2006) · New England Journal of Medicine · doi:10.1056/nejmc060228 · Cited by 67 · see citing works
Lumbar Drainage for the Treatment of Severe Bacterial Meningitis
Abulhasan, Y. B., Al-Jehani, H. M., Valiquette, M.-A., et al. (2013) · Neurocritical Care · doi:10.1007/s12028-013-9853-y · Cited by 60 · see citing works
Richards, P. G., & Towu-Aghantse, E. (1986) · BMJ · doi:10.1136/bmj.292.6520.605 · Cited by 55 · see citing works
Development of neurological problems after lumbar puncture
Hart, I. K., Bone, I., & Hadley, D. M. (1988) · BMJ · doi:10.1136/bmj.296.6614.51 · Cited by 39 · see citing works
Cranial CT before Lumbar Puncture in Suspected Meningitis
Kastenbauer, S., Winkler, F., & Pfister, H.-W. (2002) · New England Journal of Medicine · doi:10.1056/nejm200204183461615 · Cited by 39 · see citing works
Costerus, J. M., Brouwer, M. C., Bijlsma, M. W., et al. (2016) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2016.07.026 · Cited by 30 · see citing works
Self-citationLarsen, L., Poulsen, F. R., Nielsen, T. H., et al. (2017) · Scandinavian Journal of Infectious Diseases · doi:10.1080/23744235.2016.1269265 · Cited by 30 · see citing works
Cranial Imaging and Lumbar Puncture in Patients With Suspected Central Nervous System Infection
Costerus, J. M., Lemmens, C. M. C., van de Beek, D., & Brouwer, M. C. (2019) · Clinical Infectious Diseases · doi:10.1093/cid/ciz694 · Cited by 21 · see citing works
Self-citationCerebral herniation after lumbar puncture in sarcoid meningitis
Scott, T. F. M. (2000) · Clinical Neurology and Neurosurgery · doi:10.1016/s0303-8467(99)00066-9 · Cited by 20 · see citing works
COMPUTED TOMOGRAPHY OF THE HEAD BEFORE LUMBAR PUNCTURE IN ADULTS WITH SUSPECTED MENINGITIS
&NA; (2002) · Infectious Diseases in Clinical Practice · doi:10.1097/00019048-200201000-00015 · Cited by 20 · see citing works
Cerebral herniation during bacterial meningitis in children
Lane, P. W. (1993) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(05)82023-2 · Cited by 6 · see citing works
Symon, D. N. K. (1986) · BMJ · doi:10.1136/bmj.292.6523.828-a · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Community-acquired acute bacterial meningitis in adults: a clinical update
Ellis, J., Luintel, A., Chandna, A., & Heyderman, R. S. (2019) · British Medical Bulletin · doi:10.1093/bmb/ldz023 · Cited by 12 · see citing works
- Authors
- Costerus, J. M., Brouwer, M. C., Sprengers, M. E. S., Roosendaal, S. D., van der Ende, A., & van de Beek, D.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Department of Medical Microbiology, Academic Medical Center, Amsterdam Neuroscience, The Netherlands
- Department of Neurology, Academic Medical Center, Amsterdam Neuroscience, The Netherlands
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-03-07
- Volume
- 67
- Issue
- 6
- Pages
- 920-926
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2791648544
- Cited by
- 49
- References
- 36
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 5 · 2022: 5 · 2021: 7 · 2020: 3 · 2019: 7 · 2018: 4
- FWCI
- 4.27
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Netherlands Organization for Health Research and Development (917.17.308, 016.116.358)
- Academic Medical Center
- European Research Council
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Health Sciences › Medicine › Neurology › Neurosurgical Procedures and Complications
- Keywords
- bacterial meningitis, lumbar puncture complications, brain herniation, cranial computed tomography, clinical deterioration, inter-rater reliability, community-acquired meningitis
- MeSH terms
- Aged, Female, Humans, Male, Middle Aged, Netherlands, Prospective Studies, Risk Factors, Skull, Spinal Cord, Spinal Puncture, Tomography, X-Ray Computed, Reproducibility of Results, Meningitis, Bacterial
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
