Cranial computed tomographic scans have little impact on management of bacterial meningitis

Am J Dis Child. 1992 Dec;146(12):1484-7. doi: 10.1001/archpedi.1992.02160240094029.


Objective: To assess which clinical features predict an increased likelihood of an abnormal computed tomographic (CT) scan and how frequently CT influences management of bacterial meningitis.

Design: Retrospective patient series.

Setting: University-affiliated hospitals in Dallas, Tex.

Patients: Three hundred thirty-seven children with bacterial meningitis, of whom 107 (32%) had undergone CT scans.

Results: One or more abnormalities were found in 52% of the initial scans. The most frequent indication for CT at our institution was persistent or secondary fever, and in 56% of these children, subdural effusion or empyema was noted. However, findings on CT rarely predicted a need for intervention. In contrast, children with focal seizures or focal neurologic signs were more likely to have brain parenchymal changes. Scans in 19 patients (12%) prompted surgical intervention, most commonly drainage of a subdural collection. The conditions of only nine children (8.4% of those who had undergone CT scans) improved following intervention that was initiated because of findings on CT.

Conclusions: Although CT scans are frequently abnormal in children with meningitis, CT seldom reveals findings that require specific intervention.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Drainage
  • Humans
  • Infant
  • Meningitis, Bacterial / physiopathology*
  • Meningitis, Bacterial / therapy
  • Retrospective Studies
  • Tomography, X-Ray Computed