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Utility of the peripheral blood white blood cell count for identifying sick young infants who need lumbar puncture.
Ann Emerg Med. 2003 Feb; 41(2):206-14.AE

Abstract

STUDY OBJECTIVE

We assess the utility of the peripheral blood WBC count as a screen for lumbar puncture among young infants evaluated for serious bacterial infections.

METHODS

We performed logistic regression modeling and receiver operating characteristic curve analysis of peripheral blood WBC count and cerebrospinal fluid WBC count for results obtained from 3- to 89-day-old infants undergoing a full sepsis evaluation.

RESULTS

Twenty-two of 5,353 (4.1 per 1,000) infants had acute bacterial meningitis. For diagnosing acute bacterial meningitis, the peripheral blood WBC count was poorly discriminating and significantly inferior to the cerebrospinal fluid WBC count. This was true both when the odds of meningitis were modeled to vary linearly and as a U-shaped function of the peripheral blood WBC count. When relying on single and interval-based high-risk thresholds of peripheral blood WBC counts alone, the majority of infants with acute bacterial meningitis would have been missed.

CONCLUSION

Decisions to perform or withhold lumbar puncture should not be based on prevailing interpretations of the total peripheral blood WBC counts to maximize detection of bacterial meningitis in young infants.

Authors+Show Affiliations

Department of Medicine, Division of Emergency Medicine, Children's Hospital, Columbus, OH, USA. bonsub@pediatrics.ohio-state.eduNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

12548270

Citation

Bonsu, Bema K., and Marvin B. Harper. "Utility of the Peripheral Blood White Blood Cell Count for Identifying Sick Young Infants Who Need Lumbar Puncture." Annals of Emergency Medicine, vol. 41, no. 2, 2003, pp. 206-14.
Bonsu BK, Harper MB. Utility of the peripheral blood white blood cell count for identifying sick young infants who need lumbar puncture. Ann Emerg Med. 2003;41(2):206-14.
Bonsu, B. K., & Harper, M. B. (2003). Utility of the peripheral blood white blood cell count for identifying sick young infants who need lumbar puncture. Annals of Emergency Medicine, 41(2), 206-14.
Bonsu BK, Harper MB. Utility of the Peripheral Blood White Blood Cell Count for Identifying Sick Young Infants Who Need Lumbar Puncture. Ann Emerg Med. 2003;41(2):206-14. PubMed PMID: 12548270.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of the peripheral blood white blood cell count for identifying sick young infants who need lumbar puncture. AU - Bonsu,Bema K, AU - Harper,Marvin B, PY - 2003/1/28/pubmed PY - 2003/2/27/medline PY - 2003/1/28/entrez SP - 206 EP - 14 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 41 IS - 2 N2 - STUDY OBJECTIVE: We assess the utility of the peripheral blood WBC count as a screen for lumbar puncture among young infants evaluated for serious bacterial infections. METHODS: We performed logistic regression modeling and receiver operating characteristic curve analysis of peripheral blood WBC count and cerebrospinal fluid WBC count for results obtained from 3- to 89-day-old infants undergoing a full sepsis evaluation. RESULTS: Twenty-two of 5,353 (4.1 per 1,000) infants had acute bacterial meningitis. For diagnosing acute bacterial meningitis, the peripheral blood WBC count was poorly discriminating and significantly inferior to the cerebrospinal fluid WBC count. This was true both when the odds of meningitis were modeled to vary linearly and as a U-shaped function of the peripheral blood WBC count. When relying on single and interval-based high-risk thresholds of peripheral blood WBC counts alone, the majority of infants with acute bacterial meningitis would have been missed. CONCLUSION: Decisions to perform or withhold lumbar puncture should not be based on prevailing interpretations of the total peripheral blood WBC counts to maximize detection of bacterial meningitis in young infants. SN - 0196-0644 UR - https://www.unboundmedicine.com/medline/citation/12548270/Utility_of_the_peripheral_blood_white_blood_cell_count_for_identifying_sick_young_infants_who_need_lumbar_puncture_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196064402849320 DB - PRIME DP - Unbound Medicine ER -