influence of consent for lumbar puncture on the outcome of suspected meningitis

ABSTRACT

In Oman, consent for lumbar puncture [LP] is infrequently given by patients and /or parents, necessitating empiric treatment. We sought to determine if refusal for LP leads to a worse clinical outcome in patients with suspected meningitis. A case-control study and retrospective review of medical records of all patients seen or hospitalized at the Sohar Regional Hospital from January 2004 through October 2005 with a diagnosis of suspected meningitis. Clinical, treatment, and outcome features were compared between subjects consenting to [n = 7] and refusing [n = 12] LP. Patients refusing LP were more likely to be younger [6 yrs vs. 25 yrs; p < 0.001] and to be admitted to the pediatric service [10/12 vs. 2/7], to receive empiric antibiotics [12/12 [100%] vs 3/7 [43%]], to have an incomplete course of antibiotics [6.4 vs. 10 days], to have a shorter duration of hospital stay [6.5 vs. 10 days], and to leave the hospital against medical advice and /or be transferred to another facility. Patients undergoing LP were more likely to have clinical improvement and be discharged home. Two patients in the LP group had treatable CNS infections [tuberculous and cryptococcal meningitis] that would not have been adequately covered by empiric antimicrobial therapy. Diagnostic LP improves the management and prognosis for patients with suspected meningitis