CT before lumbar puncture in suspected meningitis in Botswana: How established guidelines may not apply

According to established guidelines from high-income countries, computed tomography of the head (CT) is indicated before lumbar puncture (LP) in the evaluation of suspected meningitis in HIV patients. In Botswana, meningitis in HIV-infected patients is common but CT is not widely available. Objectiv...

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Main Authors: Andrew Kestler, Ngaire Caruso, Amit Chandra, David Goldfarb, Michelle Haas
Format: Article
Language:English
Published: Elsevier 2014-06-01
Series:African Journal of Emergency Medicine
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2211419X13002334
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author Andrew Kestler
Ngaire Caruso
Amit Chandra
David Goldfarb
Michelle Haas
author_facet Andrew Kestler
Ngaire Caruso
Amit Chandra
David Goldfarb
Michelle Haas
author_sort Andrew Kestler
collection DOAJ
description According to established guidelines from high-income countries, computed tomography of the head (CT) is indicated before lumbar puncture (LP) in the evaluation of suspected meningitis in HIV patients. In Botswana, meningitis in HIV-infected patients is common but CT is not widely available. Objective: Develop a rational, evidence-based approach to CT use in the emergency evaluation of suspected meningitis in a population with high HIV prevalence. Methods: Emergency center (EC) staff at Princess Marina Hospital in Gaborone, Botswana, reviewed indications for CT and LP in suspected meningitis. The authors considered existing evidence for CT before LP (mostly from high-income countries) and considered the epidemiology of central nervous system infections in Southern Africa. Draft guidelines were circulated to emergency center doctors and nurses, and to specialists in other hospital departments for review and comment before finalization. Result: Available literature seems to indicate that in Botswana it would be possible to significantly limit the use of head CT before LP in HIV positive patients without increasing the incidence or risk of herniation. The guideline includes scenarios where an LP might be indicated in the presence of focal neurological findings and in the absence of a CT, in contradiction to established guidelines. Discussion: The applicability of established guidelines for CT use in suspected meningitis is dependent on local epidemiology and resources.
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spelling doaj.art-66a74fe60d8f40bc8d99885058d77df82022-12-22T00:50:51ZengElsevierAfrican Journal of Emergency Medicine2211-419X2014-06-0142768210.1016/j.afjem.2013.07.004CT before lumbar puncture in suspected meningitis in Botswana: How established guidelines may not applyAndrew Kestler0Ngaire Caruso1Amit Chandra2David Goldfarb3Michelle Haas4Princess Marina Hospital, Department of Emergency Medicine, University of Botswana, School of Medicine, Gaborone, BotswanaPrincess Marina Hospital, Department of Emergency Medicine, University of Botswana, School of Medicine, Gaborone, BotswanaPrincess Marina Hospital, Department of Emergency Medicine, University of Botswana, School of Medicine, Gaborone, BotswanaDepartment of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON, CanadaBotswana-University of Pennsylvania Partnership, Gaborone, BotswanaAccording to established guidelines from high-income countries, computed tomography of the head (CT) is indicated before lumbar puncture (LP) in the evaluation of suspected meningitis in HIV patients. In Botswana, meningitis in HIV-infected patients is common but CT is not widely available. Objective: Develop a rational, evidence-based approach to CT use in the emergency evaluation of suspected meningitis in a population with high HIV prevalence. Methods: Emergency center (EC) staff at Princess Marina Hospital in Gaborone, Botswana, reviewed indications for CT and LP in suspected meningitis. The authors considered existing evidence for CT before LP (mostly from high-income countries) and considered the epidemiology of central nervous system infections in Southern Africa. Draft guidelines were circulated to emergency center doctors and nurses, and to specialists in other hospital departments for review and comment before finalization. Result: Available literature seems to indicate that in Botswana it would be possible to significantly limit the use of head CT before LP in HIV positive patients without increasing the incidence or risk of herniation. The guideline includes scenarios where an LP might be indicated in the presence of focal neurological findings and in the absence of a CT, in contradiction to established guidelines. Discussion: The applicability of established guidelines for CT use in suspected meningitis is dependent on local epidemiology and resources.http://www.sciencedirect.com/science/article/pii/S2211419X13002334HIVComputed tomographyLumbar punctureAfricaMeningitisEmergency care
spellingShingle Andrew Kestler
Ngaire Caruso
Amit Chandra
David Goldfarb
Michelle Haas
CT before lumbar puncture in suspected meningitis in Botswana: How established guidelines may not apply
African Journal of Emergency Medicine
HIV
Computed tomography
Lumbar puncture
Africa
Meningitis
Emergency care
title CT before lumbar puncture in suspected meningitis in Botswana: How established guidelines may not apply
title_full CT before lumbar puncture in suspected meningitis in Botswana: How established guidelines may not apply
title_fullStr CT before lumbar puncture in suspected meningitis in Botswana: How established guidelines may not apply
title_full_unstemmed CT before lumbar puncture in suspected meningitis in Botswana: How established guidelines may not apply
title_short CT before lumbar puncture in suspected meningitis in Botswana: How established guidelines may not apply
title_sort ct before lumbar puncture in suspected meningitis in botswana how established guidelines may not apply
topic HIV
Computed tomography
Lumbar puncture
Africa
Meningitis
Emergency care
url http://www.sciencedirect.com/science/article/pii/S2211419X13002334
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