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

* Objective.--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. Design.--Retrospective patient series. Setting.--University-affiliated hospitals in Dallas, Tex. Patients.--Three hundred thirty-seven children with bacterial meningitis, of whom 107 (32%) had undergone CT scans. Results.--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. Conclusions.--Although CT scans are frequently abnormal in children with meningitis, CT seldom reveals findings that require specific intervention. (AJDC. 1992;146:1484-1487)