Emergency Department, Inpatient and ICU Clinical Pathway for Children with Suspected Meningitis Age > 56 Days
Front-line Ordering Clinician (FLOC)/RN Team Assessment
- Sepsis huddle as clinically indicated
- History & Physical
- IV access, Recommended Labs
- Consider LMX (lidocaine) cream to lower back
- Consider NPO status for lumbar puncture (LP), imaging
Assess Patient Characteristics Prior to Performing
Lumbar Puncture (LP)
Proceed with LP
Perform LP, send CSF Studies
Unable to obtain CSF
Await results of LP before starting antibiotics
CSF findings consistent
with bacterial meningitis
with bacterial meningitis
CSF findings not consistent
with bacterial meningitis
with bacterial meningitis
CSF findings consistent
with bacterial meningitis
with bacterial meningitis
Interpretation of CSF Results
Typical CSF parameters
including focal bacterial infection (parameningeal abscess or empyema) and HSV encephalitis
Delay LP
- Inpatient Definitive Management
- General Management
- Consults
- Vascular Access
- Definitive Therapy Recommendations
- Chemoprophylaxis for Patient Contacts
Inpatient Discharge Planning Consultant Follow-up
Posted: December 2017
Revised: June 2022
Authors: S. Sanjeev, MD; K. Chiotos, MD; B. Ku, MD; J. Huh, MD; T. Kaur, MD; B. Greywood, MD; J. McGuire MD, MSCE; A. Marchegiani, AuD; S. Weiss, MD
Revised: June 2022
Authors: S. Sanjeev, MD; K. Chiotos, MD; B. Ku, MD; J. Huh, MD; T. Kaur, MD; B. Greywood, MD; J. McGuire MD, MSCE; A. Marchegiani, AuD; S. Weiss, MD
Evidence
- Practice Guidelines for the Management of Bacterial Meningitis
- Bacterial Meningitis and Meningococcal Septicaemia in Children.
- Corticosteroids for Acute Bacterial Meningitis.
- Clinical Prediction Rule for Identifying Children with Cerebrospinal Fluid Pleocytosis at Very Low Risk of Bacterial Meningitis.
- Assessment of Diagnostic Yield of Nonculture Infection Testing on Cerebrospinal Fluid in Immune-Competent Children