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Predictors of cerebrospinal fluid pleocytosis in febrile infants aged 0 to 90 days.
Pediatr Emerg Care. 2008 May; 24(5):287-93.PE

Abstract

BACKGROUND

Young infants with fever routinely undergo laboratory evaluation, and many are treated with empirical antibiotics even when the infant seems well. The requirement of a lumbar puncture (LP) as part of a routine evaluation is debated; however, administration of antibiotics without an LP can cause concerns for partially treated bacterial meningitis and make subsequent evaluation of the cerebrospinal fluid (CSF) confusing. The ability to predict which febrile infants have a CSF pleocytosis would assist in the decision to perform LP in febrile infants.

OBJECTIVE

To develop a model to predict which febrile infants have a CSF pleocytosis.

METHODS

We conducted a retrospective review of febrile children aged 90 days or younger seen in the emergency department. Electronic data sources provided the age of the infant, the triage temperature, and all laboratory values. After univariate analysis, recursive partitioning analysis was performed to develop a decision tree to predict febrile infants at increased risk for CSF pleocytosis, defined as a CSF white blood cell (WBC) count of 25/microL or greater in infants 28 days old or younger and 10/microL or greater in those 29 to 90 days old.

RESULTS

Two thousand three febrile infants were studied; 176 (8.8%; 95% confidence interval [CI], 7.6%-10.1%) had a CSF pleocytosis. Presentation during the summer season increased the risk of pleocytosis from 5.0% during nonsummer months to 17.4% (95% CI, 14.6%-20.6%). During the nonsummer season, 7.3% (95% CI, 5.6%-9.5%) of febrile infants with a temperature of greater than 38.4 degrees C and a WBC count of greater than 6100/microL had a CSF pleocytosis, as opposed to 2.9% (95% CI, 1.9%-4.4%) of those with lower temperature or lower WBC count. The decision tree has an overall sensitivity of 89% (95% CI, 83%-92%) and a negative predictive value of 97% (95% CI, 96%-98%).

CONCLUSIONS

A significant number of well-appearing febrile infants will have a CSF pleocytosis. A simple decision tree based on objective clinical information can help identify those at greatest risk for CSF pleocytosis.

Authors+Show Affiliations

Division of Emergency Medicine, Children's Hospital, Boston, MA 02115, USA.william.meehan@childrens.harvard.eduNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18496111

Citation

Meehan, William P., and Richard G. Bachur. "Predictors of Cerebrospinal Fluid Pleocytosis in Febrile Infants Aged 0 to 90 Days." Pediatric Emergency Care, vol. 24, no. 5, 2008, pp. 287-93.
Meehan WP, Bachur RG. Predictors of cerebrospinal fluid pleocytosis in febrile infants aged 0 to 90 days. Pediatr Emerg Care. 2008;24(5):287-93.
Meehan, W. P., & Bachur, R. G. (2008). Predictors of cerebrospinal fluid pleocytosis in febrile infants aged 0 to 90 days. Pediatric Emergency Care, 24(5), 287-93. https://doi.org/10.1097/PEC.0b013e31816ecbb0
Meehan WP, Bachur RG. Predictors of Cerebrospinal Fluid Pleocytosis in Febrile Infants Aged 0 to 90 Days. Pediatr Emerg Care. 2008;24(5):287-93. PubMed PMID: 18496111.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of cerebrospinal fluid pleocytosis in febrile infants aged 0 to 90 days. AU - Meehan,William P,3rd AU - Bachur,Richard G, PY - 2008/5/23/pubmed PY - 2008/7/4/medline PY - 2008/5/23/entrez SP - 287 EP - 93 JF - Pediatric emergency care JO - Pediatr Emerg Care VL - 24 IS - 5 N2 - BACKGROUND: Young infants with fever routinely undergo laboratory evaluation, and many are treated with empirical antibiotics even when the infant seems well. The requirement of a lumbar puncture (LP) as part of a routine evaluation is debated; however, administration of antibiotics without an LP can cause concerns for partially treated bacterial meningitis and make subsequent evaluation of the cerebrospinal fluid (CSF) confusing. The ability to predict which febrile infants have a CSF pleocytosis would assist in the decision to perform LP in febrile infants. OBJECTIVE: To develop a model to predict which febrile infants have a CSF pleocytosis. METHODS: We conducted a retrospective review of febrile children aged 90 days or younger seen in the emergency department. Electronic data sources provided the age of the infant, the triage temperature, and all laboratory values. After univariate analysis, recursive partitioning analysis was performed to develop a decision tree to predict febrile infants at increased risk for CSF pleocytosis, defined as a CSF white blood cell (WBC) count of 25/microL or greater in infants 28 days old or younger and 10/microL or greater in those 29 to 90 days old. RESULTS: Two thousand three febrile infants were studied; 176 (8.8%; 95% confidence interval [CI], 7.6%-10.1%) had a CSF pleocytosis. Presentation during the summer season increased the risk of pleocytosis from 5.0% during nonsummer months to 17.4% (95% CI, 14.6%-20.6%). During the nonsummer season, 7.3% (95% CI, 5.6%-9.5%) of febrile infants with a temperature of greater than 38.4 degrees C and a WBC count of greater than 6100/microL had a CSF pleocytosis, as opposed to 2.9% (95% CI, 1.9%-4.4%) of those with lower temperature or lower WBC count. The decision tree has an overall sensitivity of 89% (95% CI, 83%-92%) and a negative predictive value of 97% (95% CI, 96%-98%). CONCLUSIONS: A significant number of well-appearing febrile infants will have a CSF pleocytosis. A simple decision tree based on objective clinical information can help identify those at greatest risk for CSF pleocytosis. SN - 1535-1815 UR - https://www.unboundmedicine.com/medline/citation/18496111/Predictors_of_cerebrospinal_fluid_pleocytosis_in_febrile_infants_aged_0_to_90_days_ L2 - https://doi.org/10.1097/PEC.0b013e31816ecbb0 DB - PRIME DP - Unbound Medicine ER -