Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture

被引:39
|
作者
Lyons, Todd W. [1 ]
Cruz, Andrea T. [2 ,3 ]
Freedman, Stephen B. [4 ,5 ]
Neuman, Mark I. [1 ]
Balamuth, Fran [6 ]
Mistry, Rakesh D. [7 ]
Mahajan, Prashant [8 ]
Aronson, Paul L. [9 ,10 ]
Thomson, Joanna E. [11 ]
Pruitt, Christopher M. [12 ]
Shah, Samir S. [11 ]
Nigrovic, Lise E. [1 ]
机构
[1] Boston Childrens Hosp, Div Emergency Med, Boston, MA 02115 USA
[2] Baylor Coll Med, Sect Pediat Emergency Med, Houston, TX 77030 USA
[3] Baylor Coll Med, Sect Pediat Infect Dis, Houston, TX 77030 USA
[4] Alberta Childrens Prov Gen Hosp, Res Inst, Sect Pediat Emergency Med, Calgary, AB, Canada
[5] Alberta Childrens Prov Gen Hosp, Res Inst, Sect Gastroenterol, Calgary, AB, Canada
[6] Childrens Hosp Philadelphia, Div Emergency Med, Philadelphia, PA 19104 USA
[7] Univ Colorado Hosp, Childrens Hosp Colorado, Pediat Emergency Med Dept, Aurora, CO USA
[8] Childrens Hosp Michigan, Div Pediat Emergency Med, Detroit, MI 48201 USA
[9] Yale Sch Med, Dept Pediat, New Haven, CT USA
[10] Yale Sch Med, Dept Emergency Med, New Haven, CT USA
[11] Cincinnati Childrens Hosp Med Ctr, Div Hosp Med, Cincinnati, OH 45229 USA
[12] Univ Alabama Birmingham, Div Pediat Emergency Med, Birmingham, AL USA
基金
美国国家卫生研究院;
关键词
FEBRILE INFANTS; BACTERIAL-MENINGITIS; CHILDREN; MANAGEMENT; AGE; PLEOCYTOSIS; ASSOCIATION; DISEASE; RISK;
D O I
10.1016/j.annemergmed.2016.10.008
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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/mm(3)) 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/m m(3) 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.
引用
收藏
页码:622 / 631
页数:10
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