From the TR: CT before Lumbar Puncture

8/12/2016

Before every lumbar puncture many providers reactively get a CT to rule out a mass or reduce the risk of herniation, However, not every patient requires a CT.

If your patient meets the criteria below, they have a 97% negative predictive value (i.e. 97% chance of having a negative head CT.

Age <60
Not immunocompromised
No prior CNS disease
No seizures for one week
Can answer 2 questions and follow 2 consecutive commands

Cannot have:

Altered mental status
Gaze Palsy
Abnormal visual fields
Facial palsy
Arm drift
Leg drift
Abnormal language

lumbar_puncture_ct.pdf
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Pediatrics

A review of pediatric lumbar puncture and meningitis recommends not scanning any pediatric patients suspected to have bacterial meningitis, because is delays antibiotics and would be normal in the case of increased ICP.

pediatric_lp.pdf
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Lumbar Puncture Checklist

lumbar_puncture_checklist.pdf
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