CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Practice Guideline Guideline
Palliative care: principles and pracice. Section of Palliative Care, Ontario Medical Association.
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Review
Computed tomography before lumbar puncture in acute meningitis: a review of the risks and benefits.
To determine the indications, if any, for routine computed tomography (CT) of the brain before lumbar puncture in the management of acute meningitis. ⋯ (a) There is no evidence to recommend CT of the brain before lumbar puncture in acute meningitis unless the patient shows atypical features, (b) for patients with papilledema the risks associated with lumbar puncture are 10 to 20 times lower than the risks associated with acute bacterial meningitis alone, (c) CT may be necessary if there is no prompt response to therapy for meningitis or if complications are suspected, (d) the inability to visualize the optic fundi because of cataracts or senile miosis is not an indication for CT and (e) there are no Canadian legal precedents suggesting liability if physicians fail to perform CT in cases of meningitis.
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Editorial Comment
Ontario palliative care statement: a template for the rest of Canada.