Adherence to the IDSA guidelines for brain imaging before lumbar puncture in communityacquired meningitis

ABSTRACT

@#Background: The Infectious Diseases Society of America (IDSA) has published guidelines indicating the criteria for brain imaging before lumbar puncture (LP) among patients with community-acquired meningitis (CAM). However, data on adherence to the guidelines and associated outcomes are currently limited. Methods: We conducted a prospective observational study among patients with CAM from January 2018 to March 2019 in the emergency department (ED) of a tertiary-care hospital in Thailand. Physicians’ IDSA guidelines adherence rate for brain imaging before LP was determined. Clinical outcomes were compared between patients undergoing the procedures according and not according to the guidelines. Results: Of the 101 patients screened, 69 were included. The physicians’ guidelines non-adherence rate for brain imaging before LP was 38%. The most common non-adherent practice wasperforming brain imaging despite no indication (96%). By multivariable logistic regression analysis, the only independent factor associated with non-adherence to the guidelines was caring patients with no indications for brain imaging before LP (P<0.001). The patients in the guidelines-adherent group were more-likely than those in the guidelines-non-adherent group to have underlying AIDS and present with seizure, while the 30-day survival rates were not different between the two groups (88% vs. 85%). Conclusions: Our study suggests a significant non-adherence to the guidelines due to the overinvestigation of the physicians in patients with no indications for brain imaging before LP. Interventions to improve physicians’ knowledge about these indications and practice are needed for better care of patients with CAM.