title: When should patients with bacterial meningitis be referred to a neurosurgical unit?
abstract: The case records of 97 patients with proven bacterial meningitis who were referred to a regional neurosurgical unit between 1964 and 1991 were reviewed. Mortality declined from 34% in the first cohort referred between the years 1964-82 to 5% for 1983-91 (X2 = 11.78; p < 0.001). Fewer patients were admitted in coma, (X2 = 4.43; p < 0.05), or with focal neurological signs (X2 = 7.57; p < 0.01) in the second cohort. The rate of referral increased in the later period but the incidence of unsuspected brain abscess (16% and 15%) did not change. There was a strong correlation between coma on admission and death, (X2 = 17.3; p < 0.001) and with brain abscess and death (X2 = 6.73; p < 0.01). In conclusion patients with known or suspected bacterial meningitis coupled with a decreasing level of consciousness or focal neurological signs should be referred to a neurosurgical centre.
authors.affiliation: Department of Clinical Neurosciences, Western General Hospital, Edinburgh.
authors.forename: E S
authors.initials: ES
authors.lastname: Ballantyne
authors.forename: R
authors.initials: R
authors.lastname: Chaseling
authors.forename: J D
authors.initials: JD
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D001922:Brain Abscess / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D008875:Middle Aged; D009493:Neurosurgery; D012017:Referral and Consultation / Q000592:standards*; D012606:Scotland / Q000453:epidemiology; D013129:Spinal Puncture; D014057:Tomography, X-Ray Computed