Adherence to the IDSA guidelines for brain imaging before lumbar puncture in communityacquired meningitis
- Author:
Siriththin Chansirkarnjana
;
Thana Khawcharoenporn
- Publication Type:Journal Article
- Keywords:
community-acquired meningitis;
adherence;
IDSA guidelines;
lumbar puncture;
brain imaging
- From:Neurology Asia
2020;25(1):31-37
- CountryMalaysia
- Language:English
-
Abstract:
Background: The Infectious Diseases Society of America (IDSA) has published guidelines indicating
the criteria for brain imaging before lumbar puncture (LP) among patients with community-acquired
meningitis (CAM). However, data on adherence to the guidelines and associated outcomes are currently limited.
Methods: We conducted a prospective observational study among patients with CAM from
January 2018 to March 2019 in the emergency department (ED) of a tertiary-care hospital in Thailand.
Physicians’ IDSA guidelines adherence rate for brain imaging before LP was determined. Clinical
outcomes were compared between patients undergoing the procedures according and not according
to the guidelines. Results: Of the 101 patients screened, 69 were included. The physicians’ guidelines
non-adherence rate for brain imaging before LP was 38%. The most common non-adherent practice wasperforming brain imaging despite no indication (96%). By multivariable logistic regression analysis,
the only independent factor associated with non-adherence to the guidelines was caring patients with
no indications for brain imaging before LP (P<0.001). The patients in the guidelines-adherent group
were more-likely than those in the guidelines-non-adherent group to have underlying AIDS and present
with seizure, while the 30-day survival rates were not different between the two groups (88% vs. 85%).
Conclusions: Our study suggests a significant non-adherence to the guidelines due to the overinvestigation of the physicians in patients with no indications for brain imaging before LP. Interventions to improve physicians’ knowledge about these indications and practice are needed for better care of patients with CAM.
- Full text:7.2020my0005.pdf
