Abstract
Patients with post-traumatic meningitis (PTM) at two trauma centers from January 1992-December 1999 were retrospectively analyzed. Twenty-seven of 4,788 (0.56%) patients with head injury developed meningitis. Twenty-one (78%) patients were male. Mean age was 31.3 years. Twenty-three (85%) patients sustained blunt trauma and four (15%) had penetrating injuries. Median initial Glasgow coma scale (GCS) was 6. Twenty-one (78%) patients had pneumocephalus. Twelve (44%) patients had a cerebrospinal fluid (CSF) leak. Fever was seen in all patients and 23 (85%) displayed a decrease (greater than 2 points) in GCS. Twelve (44%) patients had an intracranial pressure (ICP) monitor, eight (30%) a ventriculostomy, and 12 (44%) underwent craniotomy prior to developing meningitis. Median interval between injury and diagnosis was 10 days. Pathogens were isolated from the CSF in 15 patients and brain tissue in one. Treatment in the remainder was based on elevated CSF white blood cell count, elevated CSF protein concentration, and low CSF glucose concentration. Measured functional outcome was good in 10 (37%) patients while 8 (30%) had a residual disability requiring dependent care and 5 (19%) remained in a vegetative state. Four (15%) patients died. Admission GCS was predictive of a good functional outcome (p < 0.01), but did not predict death from infection.
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