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

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.

Retrospective patient series.

University-affiliated hospitals in Dallas, Tex.

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

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.

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