WHEN SHOULD PATIENTS WITH BACTERIAL-MENINGITIS BE REFERRED TO A NEUROSURGICAL UNIT

The case records of 97 patients with proven bacterial meningitis who were referred to a regional neurosurgical unit between 1964 and 1991 were reviewed. Mortality declined from 34% in the first cohort referred between the years 1964-82 to 5%for 1983-91 (X2=11.78; p<0.001). Fewer patients were admitted in coma, (X2=4.43; p<0.05), or with focal neurological signs (X2=7.57; p<0.01) in the second cohort. The rate of referral increased in the later period but the incidence of unsuspected brain abscess (16% and 15%) did not change. There was a strong correlation between coma on admission and death, (X2=17.3; p<0.001) and with brain abscess and death (X2=6.73; p<0.0 ). Inconclusion patients with known or suspected bacterial meningitis coupled with a decreasing level of consciousness or focal neurological signs should be referred to a neurosurgical centre.