We thank Dr Linden and colleagues for their interest in our article1 and are pleased that our initial study generated discussion regarding the controversial issue of screening CT before LP. We agree that limiting our study to only those patients with suspected meningitis may have led to findings that were more directly applicable to this group of patients. We designed our study to look for clinical predictors of abnormal radiographic findings in all patients who underwent CT screening. This design may closely reflect the true clinical scenarios, in which multiple diagnoses are often considered. Though clinicians were asked to choose the primary reason for performing LP, this did not preclude other potential diagnoses. This was, in part, reflected by the fact that the vast majority of cerebrospinal fluid samples from patients with "suspected subarachnoid hemorrhage" were also sent for bacterial culture. However, as mentioned in our article, we do recognize the utility of CT in the diagnosis of subarachnoid hemorrhage.
Gopal AK. Cranial Computed Tomography Before Lumbar Puncture—Reply. Arch Intern Med. 2000;160(18):2868-2870. doi: