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Well appearing young infants with fever without known source in the emergency department: are lumbar punctures always necessary?
Eur J Emerg Med. 2010 Jun; 17(3):167-9.EJ

Abstract

We included 685 consecutive previously healthy well appearing infants younger than 3 months with fever without known source admitted to an Emergency Department without routinely performing lumbar punctures (LP). LP was performed in 198 infants. Of these, 36 (18.1%) showed pleocytosis. Two infants less than 15 days were diagnosed with bacterial meningitis and 47 with aseptic meningitis (6.8%). LP was not performed in 487 infants. Of these, 69 were admitted to ward (46 had urinary tract infection) and 418 were discharged. In this group, we registered 38 unscheduled revisits to the Emergency Department (four aseptic meningitis). All infants did well. It is unnecessary to perform a LP routinely on infants over 1 month of age. The decision to perform the LP in previously healthy and well appearing infants with fever without known source attended by an experienced paediatric emergency physician can be individualized with no subsequent adverse outcomes. This approach may lead to under-diagnosing nonbacterial meningitis.

Authors+Show Affiliations

Department of Paediatric Emergency, Cruces Hospital, Basque Country, Spain. smintegi@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19820403

Citation

Mintegi, Santiago, et al. "Well Appearing Young Infants With Fever Without Known Source in the Emergency Department: Are Lumbar Punctures Always Necessary?" European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine, vol. 17, no. 3, 2010, pp. 167-9.
Mintegi S, Benito J, Astobiza E, et al. Well appearing young infants with fever without known source in the emergency department: are lumbar punctures always necessary? Eur J Emerg Med. 2010;17(3):167-9.
Mintegi, S., Benito, J., Astobiza, E., Capapé, S., Gomez, B., & Eguireun, A. (2010). Well appearing young infants with fever without known source in the emergency department: are lumbar punctures always necessary? European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine, 17(3), 167-9. https://doi.org/10.1097/MEJ.0b013e3283307af9
Mintegi S, et al. Well Appearing Young Infants With Fever Without Known Source in the Emergency Department: Are Lumbar Punctures Always Necessary. Eur J Emerg Med. 2010;17(3):167-9. PubMed PMID: 19820403.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Well appearing young infants with fever without known source in the emergency department: are lumbar punctures always necessary? AU - Mintegi,Santiago, AU - Benito,Javier, AU - Astobiza,Eider, AU - Capapé,Susana, AU - Gomez,Borja, AU - Eguireun,Andere, PY - 2009/10/13/entrez PY - 2009/10/13/pubmed PY - 2011/1/7/medline SP - 167 EP - 9 JF - European journal of emergency medicine : official journal of the European Society for Emergency Medicine JO - Eur J Emerg Med VL - 17 IS - 3 N2 - We included 685 consecutive previously healthy well appearing infants younger than 3 months with fever without known source admitted to an Emergency Department without routinely performing lumbar punctures (LP). LP was performed in 198 infants. Of these, 36 (18.1%) showed pleocytosis. Two infants less than 15 days were diagnosed with bacterial meningitis and 47 with aseptic meningitis (6.8%). LP was not performed in 487 infants. Of these, 69 were admitted to ward (46 had urinary tract infection) and 418 were discharged. In this group, we registered 38 unscheduled revisits to the Emergency Department (four aseptic meningitis). All infants did well. It is unnecessary to perform a LP routinely on infants over 1 month of age. The decision to perform the LP in previously healthy and well appearing infants with fever without known source attended by an experienced paediatric emergency physician can be individualized with no subsequent adverse outcomes. This approach may lead to under-diagnosing nonbacterial meningitis. SN - 1473-5695 UR - https://www.unboundmedicine.com/medline/citation/19820403/Well_appearing_young_infants_with_fever_without_known_source_in_the_emergency_department:_are_lumbar_punctures_always_necessary L2 - https://doi.org/10.1097/MEJ.0b013e3283307af9 DB - PRIME DP - Unbound Medicine ER -