title: Retrospective analysis: are fever and altered mental status indications for lumbar puncture in a hospitalized patient who has not undergone neurosurgery?
abstract: 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.
authors.affiliation: Department of Medicine, University of Connecticut School of Medicine, Farmington, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Metersky
authors.forename: A
authors.initials: A
authors.lastname: Williams
authors.forename: A L
authors.initials: AL
authors.lastname: Rafanan
mesh_terms: D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000382:microbiology; D000075202:Contraindications; D003428:Cross Infection / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008581:Meningitis / Q000175:diagnosis / Q000453:epidemiology; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D008875:Middle Aged; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000009:adverse effects