16 Variability in lumbar punctures and neuroimaging in infants less than 90 days with acute bacterial meningitis at a provincial children’s hospital in Canada
Bibliographic record
Abstract
Abstract Background Bacterial meningitis remains a significant cause of morbidity and mortality in infants, necessitating appropriate and timely investigations and treatment. Despite this, there are no current Canadian practice guidelines outlining the recommended management of infants with bacterial meningitis beyond empiric antimicrobial choice. As bacterial meningitis remains one of the most severe infectious diseases managed by general pediatricians, it warrants an attempt at practice standardization. Objectives The purpose of this study is to review and identify variation in the timing and frequency of lumbar punctures (LPs) and the use of neuroimaging for the management of bacterial meningitis for infants less than 90 days of age at BC Children’s & Women’s Hospital (BCCWH). Design/Methods A retrospective chart review at BCCWH identified confirmed, presumed or possible bacterial meningitis in infants less than 90 days of age over a five-year period (2013-2018). Anonymized data was collected from medical charts, de-identified and stored in REDCap. Results Eighty-one patients were included. Fifty-three percent of all patients had a delay in receiving an initial LP. The most common reasons for delays were that the patient was too unstable (42%) or that the first LP attempt was unsuccessful (26%). Forty-six percent of all patients had only one LP while 36% had at least one repeat LP. Most repeat LPs were done within 7 days of diagnosis. Twenty-nine percent of patients had an end of treatment LPs. Of all patients, 80% had neuroimaging. Head ultrasound (US) was the most commonly used imaging modality for both first image (68%) and subsequent images (64%). Seventeen percent of patients received a CT scan and 15% an MRI as their first image. In most cases, there was no clear clinical indication for imaging noted other than a diagnosis of meningitis (44%). Conclusion This retrospective study confirms that there is variability in the management of bacterial meningitis with respect to lumbar punctures and neuroimaging in young infants. The findings demonstrate LPs are commonly delayed, and suggest a need to develop clearly defined criteria for evaluating instability before an initial LP. Furthermore, the findings raise concern regarding the common practice of ordering head ultrasound for meningitis, given lower sensitivity in detecting disease complications and therefore disputed clinical utility.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".