Diagnostic Imaging Clinical Effectiveness fact sheet: suspected meningitis - role of lumbar puncture and computed tomography.
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Adult↗
Biomedical subjects
J de Campo
Publications and source records attributed to J de Campo.
Re: Career paths of obstetricians and gynaecologists trained at The Royal Women's Hospital, Melbourne.
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Australia↗
Cerebral herniation during bacterial meningitis in children.
OBJECTIVE: To see whether the incidence of cerebral herniation is increased immediately after lumbar puncture in children with bacterial meningitis and whether any children with herniation have normal results on cranial computed tomography. DESIGN: Retrospective review of case notes; computed tomograms were read again. SETTING: Large paediatric teaching hospital. SUBJECTS: 445 children over 30 days old admitted to hospital with bacterial meningitis. MAIN OUTCOME MEASURES: Timing of herniation in relation to lumbar puncture; findings on computed tomography in children with herniation. RESULTS: Cerebral herniation was detected in 19 (4.3%) of the 445 children (21 episodes; herniation occurred twice in two children). Herniation occurred in 14 (45%) of the 31 children who died. Nineteen episodes of herniation occurred in the 17 children who had a lumbar puncture; 12 of the episodes occurred in the first 12 hours after the lumbar puncture and seven over six other 12 hour periods (odds ratio 32.6 (95% confidence interval 8.5 to 117.3); p < 0.001). The results of cranial computed tomography were normal in five (36%) of the 14 episodes of herniation in which scanning was performed at about the time of herniation. CONCLUSIONS: The temporal relation between lumbar puncture and herniation strongly suggests that a lumbar puncture may cause herniation in some patients, and normal results on computed tomography do not mean that it is safe to do a lumbar puncture in a child with bacterial meningitis.
Adolescent↗
Clinical signs of pneumonia in children.
Clinical and chest radiographic findings were recorded prospectively in 185 children with cough who attended an outpatient clinic in Papua New Guinea. Children were studied if they were between 8 weeks and 6 years of age; patients with wheeze, stridor, measles, or pertussis were excluded. 56 children (30%) had radiological evidence of pneumonia. The presence of either a respiratory rate greater than or equal to 50/min or chest indrawing, or of both signs, was a good indication of pneumonia, with a predictive power of 46% for a positive test and 83% for a negative test. A more complex definition of tachypnoea, as a respiratory rate greater than or equal to 40/min in children over 12 months old and greater than or equal to 50/min in infants, showed little additional diagnostic benefit.
Child, Preschool↗
Allergic reaction following micturating cystourethrography.
Adverse reactions associated with the parenteral use of contrast agents are widely recognized, but reactions to contrast agents used in micturating cystourethrography (MCU) are much less common, although absorption of contrast media through intact bladder mucosa has been documented. A significant adverse reaction to ionic contrast material used for MCU in which neither reflux nor traumatic urethral catheterization could be implicated is presented. This case illustrates that significant reactions can occur during MCU and appropriate resuscitation facilities must be available. In a patient with a history of reaction to IV contrast media, the need for MCU should be reviewed and consideration given to nuclear medicine MCU. If a radiologic MCU is needed, consideration should be given to performing it in the hospital, with nonionic contrast media and steroid premedication.
Administration, Intravesical↗
How useful is the skull x-ray examination in trauma?
Abnormalities were detected only in 24 (2.3%) of 1053 skull X-ray examinations performed in cases of suspected head trauma, at a cost of $1461 per positive finding. Only in six cases (0.6%) was treatment influenced by the radiological findings. Skull X-ray examination is indicated if a depressed fracture, compound fracture, or radio-opaque foreign body is suspected, and these patients are reliably selected by certain clinical criteria. The skull X-ray film is not a reliable guide to the presence or extent of intracranial injury, nor is it a substitute for careful clinical evaluation, observation and re-evaluation. The medicolegal implications of this restrictive policy are discussed.
Aged↗