Mortality and sequelae associated with regional use of intracranial devices among patients with pneumococcal meningitis; a nationwide, population-based cohort study

Objectives: Intracranial devices may be used to treat or guide the treatment of increased intracranial pressure in patients with pneumococcal meningitis. European guidelines do not recommend the routine use of intracranial devices in the management of pneumococcal meningitis. However, in some countries, intracranial devices are used routinely, but the effect remains unknown. We aimed to examine whether mortality and sequelae were lower in patients with pneumococcal meningitis admitted to hospitals in regions where intracranial devices were routinely used compared with regions not utilizing intracranial devices routinely in pneumococcal meningitis management. Methods: In a registry-based, nationwide, population-based cohort study, we examined patients with pneumococcal meningitis (Denmark, 2004–2021). Patients were categorized according to whether the individual was admitted to hospitals in regions where intracranial devices were routinely (exposed patients, n = 305 of whom 66 (22%) had an intracranial device) or not routinely used (non-exposed patients, n = 333 of whom 4 (1%) had intracranial devices). We used Cox regression to calculate adjusted mortality rate ratios (aMRR) and hazard ratios of sequelae for the short-term and long-term periods (<6 or ≥6 months after study inclusion). Results: The short-term cumulative incidence of death was 22% among exposed patients and 22% among non-exposed patients. We found no association between mortality and routine use of intracranial devices in the region in which patients with pneumococcal meningitis were admitted (short-term aMRR [95% CI], 0.9 [0.6–1.3]; long-term aMRR [95% CI], 1.0 [0.7–1.6]). Furthermore, our study did not demonstrate lower risks of diagnosis of epilepsy, hearing loss, diagnoses suggestive of brain damage, disability pension, or shorter length of stay in exposed compared with non-exposed patients with pneumococcal meningitis. Discussion: The routine use of intracranial devices is not associated with lower mortality or morbidity among patients with pneumococcal meningitis.