From the TR: CT before Lumbar Puncture

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
File Size:	97 kb
File Type:	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
File Size:	238 kb
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Lumbar Puncture Checklist

lumbar_puncture_checklist.pdf
File Size:	171 kb
File Type:	pdf

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