Journal Article

Retrospective Analysis: Are Fever and Altered Mental Status Indications for Lumbar Puncture in a Hospitalized Patient Who Has Not Undergone Neurosurgery?

Mark L. Metersky, Andrew Williams and Albert L. Rafanan

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 25, issue 2, pages 285-288
Published in print August 1997 | ISSN: 1058-4838
Published online August 1997 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/514531
Retrospective Analysis: Are Fever and Altered Mental Status Indications for Lumbar Puncture in a Hospitalized Patient Who Has Not Undergone Neurosurgery?

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Although nosocomial meningitis is rare in nonsurgical patients, lumbar punctures are frequently performed on hospitalized medical patients who develop delirium and/or fever. A retrospective review was undertaken to determine the yield of lumbar puncture in this setting and to compare it with the yield for suspected community-acquired meningitis. Of 232 lumbar punctures studied, 51 (22%) were performed to rule out nosocomial meningitis, while 181 (78%) were done to rule out community-acquired meningitis. No lumbar puncture performed for suspected nosocomial meningitis was positive, while results of 26 (14%) of those done for suspected community-acquired meningitis were abnormal (P < .01). Patients whose lumbar punctures were positive more often had headache or meningeal signs than those whose lumbar punctures were negative, and only 11 patients (22%) who had lumbar punctures performed for suspected nosocomial meningitis had headache or meningeal signs. We conclude that lumbar punctures performed for suspected nosocomial meningitis in nonsurgical patients have a low yield and that in some low-risk patients without headache or meningeal signs, lumbar puncture may be unnecessary.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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