Elizabeth W Pingree1, Amir A Kimia, Lise E Nigrovic. 1. Department of Medicine, Boston Children's Hospital, Boston, MA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA.
Abstract
OBJECTIVES: The authors measured the effect of a traumatic or unsuccessful lumbar puncture (LP) on the management of febrile infants. METHODS: This was a 10-year retrospective cross-sectional study of low-risk infants by the "Boston" criteria 28 to 60 days of age presenting to the emergency department for evaluation of fever. "Normal LP" infants had cerebrospinal fluid (CSF) WBC < 10 × 10(6) cells/L. "Traumatic" or "unsuccessful LP" infants had CSF red blood cell count ≥ 10 × 10(9) cells/L or no CSF cell counts obtained, respectively. A serious bacterial infection (SBI) was defined as growth of a bacterial pathogen from culture. The hospitalization and SBI rates were compared between infants with normal versus traumatic or unsuccessful LPs. RESULTS: Of the 929 study infants, 756 (81.4%) had normal LPs, and 173 (18.6%) had traumatic or unsuccessful LPs. Infants with traumatic or unsuccessful LPs had a higher hospitalization rate (72.3% traumatic or unsuccessful LP vs. 18.1% normal LP; difference = 54.1%; 95% confidence interval [CI] = 46.4% to 60.8%), but a similar SBI rate (2.9% vs. 4.1%; difference = 1.2%; 95% CI = -2.7% to 3.6%). No infant had proven bacterial meningitis (0% risk, 95% CI = 0 to 0.3%). CONCLUSIONS: Low-risk infants aged 28 to 60 days with traumatic or unsuccessful LPs are more frequently hospitalized, although SBI rates were similar to those of infants with normal LPs.
OBJECTIVES: The authors measured the effect of a traumatic or unsuccessful lumbar puncture (LP) on the management of febrile infants. METHODS: This was a 10-year retrospective cross-sectional study of low-risk infants by the "Boston" criteria 28 to 60 days of age presenting to the emergency department for evaluation of fever. "Normal LP" infants had cerebrospinal fluid (CSF) WBC < 10 × 10(6) cells/L. "Traumatic" or "unsuccessful LP" infants had CSF red blood cell count ≥ 10 × 10(9) cells/L or no CSF cell counts obtained, respectively. A serious bacterial infection (SBI) was defined as growth of a bacterial pathogen from culture. The hospitalization and SBI rates were compared between infants with normal versus traumatic or unsuccessful LPs. RESULTS: Of the 929 study infants, 756 (81.4%) had normal LPs, and 173 (18.6%) had traumatic or unsuccessful LPs. Infants with traumatic or unsuccessful LPs had a higher hospitalization rate (72.3% traumatic or unsuccessful LP vs. 18.1% normal LP; difference = 54.1%; 95% confidence interval [CI] = 46.4% to 60.8%), but a similar SBI rate (2.9% vs. 4.1%; difference = 1.2%; 95% CI = -2.7% to 3.6%). No infant had proven bacterial meningitis (0% risk, 95% CI = 0 to 0.3%). CONCLUSIONS: Low-risk infants aged 28 to 60 days with traumatic or unsuccessful LPs are more frequently hospitalized, although SBI rates were similar to those of infants with normal LPs.
Authors: Todd W Lyons; Andrea T Cruz; Stephen B Freedman; Mark I Neuman; Fran Balamuth; Rakesh D Mistry; Prashant Mahajan; Paul L Aronson; Joanna E Thomson; Christopher M Pruitt; Samir S Shah; Lise E Nigrovic Journal: Ann Emerg Med Date: 2016-12-29 Impact factor: 5.721
Authors: Lise E Nigrovic; Prashant V Mahajan; Stephen M Blumberg; Lorin R Browne; James G Linakis; Richard M Ruddy; Jonathan E Bennett; Alexander J Rogers; Leah Tzimenatos; Elizabeth C Powell; Elizabeth R Alpern; T Charles Casper; Octavio Ramilo; Nathan Kuppermann Journal: Pediatrics Date: 2017-06-06 Impact factor: 7.124
Authors: Paul L Aronson; Marie E Wang; Eugene D Shapiro; Samir S Shah; Adrienne G DePorre; Russell J McCulloh; Christopher M Pruitt; Sanyukta Desai; Lise E Nigrovic; Richard D Marble; Rianna C Leazer; Sahar N Rooholamini; Laura F Sartori; Fran Balamuth; Christopher Woll; Mark I Neuman Journal: Pediatrics Date: 2018-11-13 Impact factor: 7.124
Authors: Paul L Aronson; Paula Schaeffer; Linda M Niccolai; Eugene D Shapiro; Liana Fraenkel Journal: Pediatr Emerg Care Date: 2021-12-01 Impact factor: 1.454