Todd W Lyons1, Andrea T Cruz2, Stephen B Freedman3, Mark I Neuman1, Fran Balamuth4, Rakesh D Mistry5, Prashant Mahajan6, Paul L Aronson7, Joanna E Thomson8, Christopher M Pruitt9, Samir S Shah8, Lise E Nigrovic10. 1. Division of Emergency Medicine, Boston Children's Hospital, Boston, MA. 2. Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, TX. 3. Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada. 4. Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. 5. Pediatric Emergency Medicine Department, University of Colorado Hospital/Children's Hospital Colorado, Aurora, CO. 6. Division of Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, MI. 7. Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, CT. 8. Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 9. Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL. 10. Division of Emergency Medicine, Boston Children's Hospital, Boston, MA. Electronic address: lise.nigrovic@childrens.harvard.edu.
Abstract
STUDY OBJECTIVE: We determine the optimal correction factor for cerebrospinal fluid WBC counts in infants with traumatic lumbar punctures. METHODS: We performed a secondary analysis of a retrospective cohort of infants aged 60 days or younger and with a traumatic lumbar puncture (cerebrospinal fluid RBC count ≥10,000 cells/mm3) at 20 participating centers. Cerebrospinal fluid pleocytosis was defined as a cerebrospinal fluid WBC count greater than or equal to 20 cells/mm3 for infants aged 28 days or younger and greater than or equal to 10 cells/mm3 for infants aged 29 to 60 days; bacterial meningitis was defined as growth of pathogenic bacteria from cerebrospinal fluid culture. Using linear regression, we derived a cerebrospinal fluid WBC correction factor and compared the uncorrected with the corrected cerebrospinal fluid WBC count for the detection of bacterial meningitis. RESULTS: Of the eligible 20,319 lumbar punctures, 2,880 (14%) were traumatic, and 33 of these patients (1.1%) had bacterial meningitis. The derived cerebrospinal fluid RBCs:WBCs ratio was 877:1 (95% confidence interval [CI] 805 to 961:1). Compared with the uncorrected cerebrospinal fluid WBC count, the corrected one had lower sensitivity for bacterial meningitis (88% uncorrected versus 67% corrected; difference 21%; 95% CI 10% to 37%) but resulted in fewer infants with cerebrospinal fluid pleocytosis (78% uncorrected versus 33% corrected; difference 45%; 95% CI 43% to 47%). Cerebrospinal fluid WBC count correction resulted in the misclassification of 7 additional infants with bacterial meningitis, who were misclassified as not having cerebrospinal fluid pleocytosis; only 1 of these infants was older than 28 days. CONCLUSION: Correction of the cerebrospinal fluid WBC count substantially reduced the number of infants with cerebrospinal fluid pleocytosis while misclassifying only 1 infant with bacterial meningitis of those aged 29 to 60 days.
STUDY OBJECTIVE: We determine the optimal correction factor for cerebrospinal fluid WBC counts in infants with traumatic lumbar punctures. METHODS: We performed a secondary analysis of a retrospective cohort of infants aged 60 days or younger and with a traumatic lumbar puncture (cerebrospinal fluid RBC count ≥10,000 cells/mm3) at 20 participating centers. Cerebrospinal fluid pleocytosis was defined as a cerebrospinal fluid WBC count greater than or equal to 20 cells/mm3 for infants aged 28 days or younger and greater than or equal to 10 cells/mm3 for infants aged 29 to 60 days; bacterial meningitis was defined as growth of pathogenic bacteria from cerebrospinal fluid culture. Using linear regression, we derived a cerebrospinal fluid WBC correction factor and compared the uncorrected with the corrected cerebrospinal fluid WBC count for the detection of bacterial meningitis. RESULTS: Of the eligible 20,319 lumbar punctures, 2,880 (14%) were traumatic, and 33 of these patients (1.1%) had bacterial meningitis. The derived cerebrospinal fluid RBCs:WBCs ratio was 877:1 (95% confidence interval [CI] 805 to 961:1). Compared with the uncorrected cerebrospinal fluid WBC count, the corrected one had lower sensitivity for bacterial meningitis (88% uncorrected versus 67% corrected; difference 21%; 95% CI 10% to 37%) but resulted in fewer infants with cerebrospinal fluid pleocytosis (78% uncorrected versus 33% corrected; difference 45%; 95% CI 43% to 47%). Cerebrospinal fluid WBC count correction resulted in the misclassification of 7 additional infants with bacterial meningitis, who were misclassified as not having cerebrospinal fluid pleocytosis; only 1 of these infants was older than 28 days. CONCLUSION: Correction of the cerebrospinal fluid WBC count substantially reduced the number of infants with cerebrospinal fluid pleocytosis while misclassifying only 1 infant with bacterial meningitis of those aged 29 to 60 days.
Authors: Paul L Aronson; Cary Thurm; Derek J Williams; Lise E Nigrovic; Elizabeth R Alpern; Joel S Tieder; Samir S Shah; Russell J McCulloh; Fran Balamuth; Amanda C Schondelmeyer; Evaline A Alessandrini; Whitney L Browning; Angela L Myers; Mark I Neuman Journal: J Hosp Med Date: 2015-02-13 Impact factor: 2.960
Authors: Harmony P Garges; M Anthony Moody; C Michael Cotten; P Brian Smith; Kenneth F Tiffany; Robert Lenfestey; Jennifer S Li; Vance G Fowler; Daniel K Benjamin Journal: Pediatrics Date: 2006-04 Impact factor: 7.124
Authors: Todd W Lyons; Andrea T Cruz; Stephen B Freedman; Joseph L Arms; Paul L Aronson; Alesia H Fleming; Dina M Kulik; Prashant Mahajan; Rakesh D Mistry; Christopher M Pruitt; Amy D Thompson; Lise E Nigrovic Journal: Pediatr Infect Dis J Date: 2017-10 Impact factor: 2.129
Authors: Eduardo Fleischer; Mark I Neuman; Marie E Wang; Lise E Nigrovic; Sanyukta Desai; Adrienne G DePorre; Rianna C Leazer; Richard D Marble; Laura F Sartori; Paul L Aronson Journal: Hosp Pediatr Date: 2019-11-05