OBJECTIVE: To assess the usage of cranial computed tomography (CT) in patients 
admitted with meningitis.
DESIGN: Retrospective study.
SETTING: Heart of England NHS foundation trust, a teaching hospital in the West 
Midlands.
PARTICIPANTS: Two groups of adult patients admitted with meningitis between 
April 2001 and September 2004 and from September 2006 until September 2009.
MAIN OUTCOME MEASURES: The numbers of patients having cranial CT and lumbar 
puncture and whether any complications had arisen following lumbar puncture. The 
appropriateness of the CT request according to local criteria.
RESULTS: A total of 111 patients were admitted in the initial time period and 47 
patients in the second time period. In the first group, 67 patients underwent CT 
(61%), compared with 36 patients (80%) in the second group. There were eight 
abnormal scans (12%) in the initial group including three patients with 
radiological features of cerebral oedema. Of these patients, one underwent 
lumbar puncture and had no neurological sequelae. In the second group, there 
were five abnormal scans (14%) with one presenting a contraindication for lumbar 
puncture due to mild ventricular dilatation. A lumbar puncture was performed in 
this patient without complication. All patients with abnormal scans had clinical 
features to suggest raised intracranial pressure. CT scan requests were 
considered inappropriate in 26% of patients in the initial study period and 56% 
of patients in the second study period.
CONCLUSION: More patients with meningitis are undergoing CT and the number of 
inappropriate requests are increasing. There are few abnormal CT scans 
presenting a contraindication for lumbar puncture and the majority of these 
patients usually have clinical signs to suggest raised intracranial pressure.