When Should Patients with Bacterial Meningitis be Referred to a Neurosurgical Unit?

Abstract

The case records of 97 patients with proven bacterial meningitis who were referred to a regional neurosurgical unit between 1964 and 1991 were reviewed. Mortality declined from 34% in the first cohort referred between the years 1964–82 to 5% for 1983–91 (X²=11.78;p<0.001). Fewer patients were admitted in coma, (X²=4.43; p<0.05), or with focal neurological signs (X²=7.57; p<0.01) in the second cohort. The rate of referral increased in the later period but the incidence of unsuspected brain abscess (16% and 15%) did not change. There was a strong correlation between coma on admission and death, (X²=17.3; p<0.001) and with brain abscess and death (X²=6.73; p<0.01). in conclusion patients with known or suspected bacterial meningitis coupled with a decreasing level of consciousness or focal neurological signs should be referred to a neurosurgical centre.