Suspected Meningitis Age > 56 days Clinical Pathway — Emergency Department, Inpatient and ICU
Suspected Meningitis Age > 56 days Clinical Pathway — Emergency Department, Inpatient and ICU
Patient Cohort
Inclusion Criteria
This pathway should be used to guide the management of patients with suspected meningitis meeting the following criteria:
- Age ≥ 56 days (for patients ≤ 56 days, see the Febrile Young Infant pathway)
- Community acquired meningitis
- ED, inpatient, ICU
Exclusion Criteria
- Neurosurgical patients
- Presence of ventricular shunt/hardware (for patients with ventricular shunts, see the Suspected Ventricular Shunt Obstruction or Infection pathway)
- Craniofacial surgery
- Indwelling epidural catheter
- Recent traumatic injury to the brain or spine
- CSF Leak
- Immunocompromised status — if suspected CNS infection in an immunocompromised host, consider ICID consult
Symptoms and Signs that May Suggest Acute Bacterial Meningitis
- Altered mental status, irritability
- Ill-appearance
- Fever
- Headache
- Photophobia
- Neck pain, back pain
- Vomiting
- Seizure
- Bulging fontanelle
- Stiff neck
- Focal neurologic deficit
- Kernig or Brudzinski sign
*These signs and symptoms of meningitis are not highly specific and can be seen with other diagnoses.
Young infants and children with neurodevelopmental disabilities or immunocompromise may not display classic signs and symptoms of meningitis. Findings may be more subtle.