Quality statement 5: Lumbar puncture for suspected bacterial meningitis

Quality statement

Children and young people with suspected bacterial meningitis have a lumbar puncture.

Quality measure

Structure: Evidence of local arrangements for children and young people with suspected bacterial meningitis to have a lumbar puncture.

Process: Proportion of children and young people with suspected bacterial meningitis who have a lumbar puncture.

Numerator – the number of people in the denominator who have a lumbar puncture.

Denominator – the number of children and young people with suspected bacterial meningitis.

What the quality statement means for each audience

Service providers ensure systems are in place for children and young people with suspected bacterial meningitis to have a lumbar puncture.

Healthcare professionals perform a lumbar puncture for children and young people with suspected bacterial meningitis.

Commissioners ensure they commission services for children and young people with suspected bacterial meningitis to have a lumbar puncture.

Children and young people with suspected bacterial meningitis have a procedure called a lumbar puncture, in which a sample of the fluid surrounding the brain and spinal cord is taken using a hollow needle inserted into the lower part of the back.

Source guidance

Meningitis (bacterial) and meningococcal septicaemia in under 16s (2010) NICE guideline CG102, recommendations 1.3.18 (key priority for implementation) and 1.3.19

Data source

Structure: Local data collection.

Process: Local data collection. Contained within the baseline assessment for the NICE guideline on meningitis (bacterial) and meningococcal septicaemia in under 16s.

Definitions

It is important that children and young people with suspected bacterial meningitis have a lumbar puncture as soon as possible, but only when it is safe to do so. Contraindications to lumbar puncture include:

  • signs suggesting raised intracranial pressure:

    • reduced or fluctuating level of consciousness (Glasgow Coma Scale score less than 9 or a drop of 3 or more)

    • age-relative bradycardia and hypertension

    • focal neurological signs

    • abnormal posture or posturing

    • unequal, dilated or poorly responsive pupils

    • papilloedema

    • abnormal 'doll's eye' movements

    • tense, bulging fontanelle

  • shock

  • extensive or spreading purpura

  • convulsions until stabilised

  • coagulation abnormalities:

    • coagulation results (if obtained) outside the normal range

    • platelet count below 100 x 109/litre

    • receiving anticoagulant therapy

  • superficial infection at the lumbar puncture site

  • respiratory insufficiency (lumbar puncture is considered to have a high risk of precipitating respiratory failure in the presence of respiratory insufficiency).