We developed a diagnostic decision rule for the indication of a lumbar puncture and empirical treatment for bacterial meningitis (9;10).
There are compression fractures of the ninth thoracic through second lumbar vertebrae.
In each of these hospitals, lumbar punctures are routinely performed on patients with suspected meningitis.
Three of these cases presented as mummy torsos with signs of severe spondylitis of the lumbar vertebral bodies and evidence for chronic pleuritis.
In the same images, the signal intensity of the skeletal muscle was also calculated using multiple measurements of the lumbar, dorsal and brachial muscles.
Minimizing lumbar punctures and empirical treatments using a diagnostic decision rule, without missing a single case of meningitis, was a dominant strategy to actual practice.
There were few significant differences at 6 weeks or 1 year between patients who were referred for lumbar spine x-ray and those who were not.
External lumbar drainage for 72 hours may be the most accurate test to predict response to shunting, but requires hospitalization.
