Table 1.
Baseline Characteristics of 614 Adults With Community-Acquired Meningitis
| Clinical Features | CT Indicated (n = 207) | CT Not Indicated (n = 407) | P Value |
|---|---|---|---|
| Age, y, median (range) | 46 (18–92) | 34 (18–89) | <.001 |
| Female sex | 89 (42.4) | 238 (58.2) | <.001 |
| Race | |||
| White | 80 (38.1) | 207 (50.6) | <.001 |
| African American | 71 (33.8) | 97 (23.7) | <.001 |
| Hispanic | 53 (25.2) | 93 (22.7) | .49 |
| Other | 6 (2.9) | 12 (2.9) | .96 |
| Coexisting medical conditions | |||
| Charlson comorbidity index score ≥1 | 131 (62.4) | 36 (8.8) | <.001 |
| HIV/AIDS* | 63/207 (30.4) | 1 (0.2) | <.001 |
| History of injection drug use | 11/203 (5.4) | 1 (0.2) | <.001 |
| Sinusitis or otitis | 27 (12.9) | 14 (3.4) | <.001 |
| History of CNS lesion* | 18 (8.6) | 0 (0.0) | <.001 |
| Presenting history | |||
| Headache | 147/190 (77.4) | 400 (97.8) | <.001 |
| Nausea | 97/186 (52.2) | 306/407 (75.2) | <.001 |
| Subjective fever | 128/203 (63.1) | 258/407 (63.3) | .97 |
| Stiff neck | 56/185 (30.3) | 209/402 (52.0) | <.001 |
| Photophobia | 34/157 (21.7) | 184/384 (47.9) | <.001 |
| Seizure* | 26/206 (12.6) | 0 (0.0) | <.001 |
| Presenting signs | |||
| Nuchal rigidity | 48/179 (26.8) | 131/395 (33.2) | .13 |
| Temperature >38.4°C | 99/205 (48.3) | 91/407 (22.3) | <.001 |
| Abnormal mental statusa,* | 118/207 (57.0) | 0/407 (0.0) | <.001 |
| GCS score <15 | 81/196 (41.3) | 0/407 (0.0) | <.001 |
| Focal neurologic deficitsb,* | 43/202 (21.3) | 0/407 (0.0) | <.001 |
| Vesicular or petechial rash | 6/200 (3.0) | 5 (1.2) | .12 |
| Papilledema | 1/2 (50.0) | 0/4 (0.0) | .12 |
| Blood and CSF analysis | |||
| CSF leukocyte, cells/μL, median (range) | 103.5 (6–53.600) | 175 (6–44040) | .009 |
| Serum leukocyte, × 103 cells/μL, median (range) | 9.4 (1.5–43.5) | 8.6 (0.9–42.0) | .006 |
| CSF protein, mg/dL, median (range) | 105.5 (21–659) | 74 (18–706) | <.001 |
| CSF glucose, mg/dL, median (range) | 52 (1–421) | 56 (1–366) | .782 |
| Management decision | |||
| Admission to hospital | 207 (99.5) | 392 (95.8) | .01 |
| Empiric antibiotic therapy | 149/205 (72.7) | 303/406 (74.6) | .60 |
| Empiric acyclovir therapy | 76/207 (36.7) | 81/407 (19.9) | <.001 |
| Head CT taken | 193 (93.2) | 356 (87.3) | .02 |
| Abnormalc | 35/193 (18.1) | 2/356 (0.05) | <.001 |
| Brain MRI taken | 146 (69.5) | 144 (35.2) | <.001 |
| Abnormald | 76/146 (52.1) | 33/144 (22.9) | <.001 |
| Clinical status at discharge | |||
| Adverse clinical outcomee | 59 (28.5) | 11 (2.7) | <.001 |
Data are presented as No. (%) unless otherwise indicated. Some denominators are presented to reflect missing data. Infectious Diseases Society of America criteria for undergoing CT prior to lumbar puncture are indicated by (*).
Abbreviations: CNS, central nervous system; CSF, cerebrospinal fluid; CT, computed tomography; GCS, Glasgow Coma Scale; HIV, human immunodeficiency virus; MRI, magnetic resonance imaging.
aDisorientation (n = 37) or Glasgow Coma Scale score <15 (n = 81).
bFocal motor deficit, cranial nerve abnormality, or aphasia.
cSee Table 4.
dMass lesions, strokes, hypoattenuations, meningeal enhancement, bleeds, white matter abnormalities.
eGlasgow Outcome Scale score of 1–4.