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Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture.
Ann Emerg Med. 2017 May; 69(5):622-631.AE

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.

Authors+Show Affiliations

Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, TX.Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.Pediatric Emergency Medicine Department, University of Colorado Hospital/Children's Hospital Colorado, Aurora, CO.Division of Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, MI.Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, CT.Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL.Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.Division of Emergency Medicine, Boston Children's Hospital, Boston, MA. Electronic address: lise.nigrovic@childrens.harvard.edu.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

28041826

Citation

Lyons, Todd W., et al. "Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture." Annals of Emergency Medicine, vol. 69, no. 5, 2017, pp. 622-631.
Lyons TW, Cruz AT, Freedman SB, et al. Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture. Ann Emerg Med. 2017;69(5):622-631.
Lyons, T. W., Cruz, A. T., Freedman, S. B., Neuman, M. I., Balamuth, F., Mistry, R. D., Mahajan, P., Aronson, P. L., Thomson, J. E., Pruitt, C. M., Shah, S. S., & Nigrovic, L. E. (2017). Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture. Annals of Emergency Medicine, 69(5), 622-631. https://doi.org/10.1016/j.annemergmed.2016.10.008
Lyons TW, et al. Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture. Ann Emerg Med. 2017;69(5):622-631. PubMed PMID: 28041826.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture. AU - Lyons,Todd W, AU - Cruz,Andrea T, AU - Freedman,Stephen B, AU - Neuman,Mark I, AU - Balamuth,Fran, AU - Mistry,Rakesh D, AU - Mahajan,Prashant, AU - Aronson,Paul L, AU - Thomson,Joanna E, AU - Pruitt,Christopher M, AU - Shah,Samir S, AU - Nigrovic,Lise E, AU - ,, Y1 - 2016/12/29/ PY - 2016/05/26/received PY - 2016/10/03/revised PY - 2016/10/05/accepted PY - 2017/1/4/pubmed PY - 2017/6/22/medline PY - 2017/1/3/entrez SP - 622 EP - 631 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 69 IS - 5 N2 - 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. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/28041826/Interpretation_of_Cerebrospinal_Fluid_White_Blood_Cell_Counts_in_Young_Infants_With_a_Traumatic_Lumbar_Puncture_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(16)31223-9 DB - PRIME DP - Unbound Medicine ER -