Table 3.
Overview of Guideline Indications for Cranial Imaging, and Proportion of Patients Fulfilling the Criteria
| Item | IDSA 2004 | n/N (%) | ESCMID 2016 | n/N (%) | Swedish Guideline 2010 | n/N (%) | Dutch Guideline 2012 | n/N (%) |
|---|---|---|---|---|---|---|---|---|
| Medical history | Immunocompromised statea or history of central nervous system diseasea | 65/203 (32%) | Immunocompromised stateb | 34/203 (17%) | No indication | … | Immunocompromised stateb | 34/203 (17%) |
| Symptoms | No indication | … | No indication | … | Long duration (>4 days) of cerebral symptomsc or ABM-atypical symptomsd | 50/203 (24%) | No indication | … |
| Epileptic seizures | New-onset seizures (<1 week of presentation) | 22/203 (11%) | New-onset seizures | 22/203 (11%) | New onset epileptic seizures without clinical picture of ABMc | 9/203 (4%) | New-onset seizures | 22/203 (11%) |
| Mental status | GCS score <15 | 91/203 (45%) | GCS score <10 | 17/203 (8%) | Unconsciousness plus ≥1 of the following clinical findings: rigid dilated pupils; increasing blood pressure and bradycardiae; disturbed breathing patterne; opisthotonus; and loss of all reactions | 4/203 (2%) | GCS score <10 | 17/203 (8%) |
| Cranial Nerves | Anisocoria, abnormal ocular motility, or visual fields | 8/203 (4%) | No indication | … | N. III palsy | 5/203 (2%) | No indication | … |
| Ophthalmoscopy | Papilledema | 2/52 (4%) | No indication | … | No indication | Papilledema | 2/52 (4%) | |
| Neurologic deficits | Limb paresis | 17/203 (8%) | Aphasia, gaze palsy, limb paresis, ataxia | 33/203 (16%) | Arm or leg drift | 17/203 (8%) | Aphasia, gaze palsy, limb paresis, ataxia | 33/203 (16%) |
| Total with indication CT | … | 129/203 (64%) | … | 80/203 (39%) | … | 78/203 (39%) | … | 81/203 (40%) |
Abbreviations: ABM, acute bacterial meningitis; AIDS, acquired immunodeficiency syndrome; CT, computed tomography; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; GCS, Glasgow Coma Scale; HIV, human immunodeficiency virus; IDSA, Infectious Disease Society of America; N. III, oculomotor nerve.
aThe IDSA guideline defines immunocompromised states as “due to HIV infection or AIDS, immunosuppressive therapy, or organ transplantation.”
bThe ESCMID guideline defines “severe immunocompromised” states as untreated HIV or organ transplant patients.
cThe Swedish and Dutch guideline defines “cerebral symptoms” as including headache, impaired mental status, nausea/vomiting, and/or (focal) seizures.
dThe Swedish guideline defines the “clinical picture of acute bacterial meningitis” as a fever or signs of infection—otitis, sinusitis, pneumonia, or pharyngitis—in combination with a headache and neck stiffness.
eNot further defined in the guideline, and left to the interpretation of the physician.