CLINICAL CORRELATION OF ASSOCIATED ANOMALIES IN DIFFERENT VARIANTS OF ANORECTAL MALFORMATION IN CHILDREN

N ZARQOON; MF GONDAL; Z AZAM; H FAROOQ; I NASEER; MF NASEER

doi:10.54112/pjicm.v5i02.234

Authors

N ZARQOON Department of Paediatric Surgery, Holy Family Hospital, Rawalpindi, Pakistan
MF GONDAL Department of Paediatric Surgery, Holy Family Hospital, Rawalpindi, Pakistan
Z AZAM Department of Paediatric Surgery, Holy Family Hospital, Rawalpindi, Pakistan
H FAROOQ Department of Paediatric Surgery, Holy Family Hospital, Rawalpindi, Pakistan
I NASEER Department of Forensic Sciences, University of Central Punjab, Lahore, Pakistan
MF NASEER Department of Physiotherapy, Intern Health Care Centre, Lahore, Pakistan,

DOI:

https://doi.org/10.54112/pjicm.v5i02.234

Keywords:

Meningitis, Computed Tomography, Lumbar Puncture, Emergency Department, Cerebrospinal Fluid

Abstract

Background: The routine use of contrast-enhanced computed tomography (CECT) prior to lumbar puncture (LP) in patients with suspected meningitis may delay definitive diagnosis and timely initiation of antimicrobial therapy. Evidence supporting the incremental diagnostic value of CECT over LP in emergency settings, particularly in low- and middle-income countries, remains limited. Objective: To compare the diagnostic significance of contrast-enhanced CT brain and lumbar puncture in adults presenting with suspected meningitis to the emergency department of a tertiary care hospital in Pakistan. Study Design: Prospective observational study. Settings: Department of Paediatric Surgery, Holy Family Hospital, Rawalpindi, Pakistan. Duration of Study: January 2024 to January 2025. Methods: Ninety consecutive adult patients presenting with clinical features suggestive of acute meningitis were enrolled. In accordance with institutional protocol, all patients underwent a contrast-enhanced CT of the brain prior to lumbar puncture. CT findings were evaluated for parenchymal abnormalities and radiological contraindications to LP. Cerebrospinal fluid (CSF) analysis served as the reference standard for confirming and classifying meningitis etiologically. Diagnostic performance indices of CECT were calculated against CSF findings. Post-stratification analysis assessed associations between CT abnormalities, presenting clinical features, and in-hospital outcomes. Statistical analysis was performed using SPSS version 26, with p < 0.05 considered statistically significant. Results: The mean age of participants was 34.8 ± 15.6 years, with a male predominance (56.7%). CSF analysis confirmed meningitis in 84.4% of cases. The predominant etiologies were bacterial (41.1%), viral (31.1%), and tuberculous meningitis (12.2%). CECT demonstrated abnormalities in 35.6% of patients and identified radiological contraindications to LP in 8.9%. Using CSF as the reference standard, CECT showed limited sensitivity (42.1%) and moderate specificity (83.3%) for meningitis-related abnormalities. CT abnormalities were significantly associated with altered level of consciousness, seizures, and papilledema (p < 0.05). Patients with abnormal CT findings experienced higher rates of intensive care unit admission, mechanical ventilation, neurological sequelae, and in-hospital mortality (all p < 0.05). Emergency department length of stay was significantly prolonged among patients undergoing CT prior to LP. Conclusion: Contrast-enhanced CT of the brain demonstrates limited sensitivity for confirming meningitis but remains valuable for identifying contraindications to lumbar puncture and stratifying patients at risk of severe outcomes. Lumbar puncture with CSF analysis remains the definitive diagnostic modality. Selective, guideline-directed use of pre-LP neuroimaging may reduce diagnostic delays and improve outcomes in resource-constrained emergency care settings.

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