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

TitleInterpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture.
Publication TypeJournal Article
Year of Publication2016
AuthorsLyons TW, Cruz AT, Freedman SB, Neuman MI, Balamuth F, Mistry RD, Mahajan P, Aronson PL, Thomson JE, Pruitt CM, Shah SS, Nigrovic LE
Corporate AuthorsPediatric Emergency Medicine Clinical Research Network(PEM CRC) Herpes Simplex Virus Study Group
JournalAnn Emerg Med
Date Published2016 Dec 29
ISSN1097-6760
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/mm(3)) at 20 participating centers. Cerebrospinal fluid pleocytosis was defined as a cerebrospinal fluid WBC count greater than or equal to 20 cells/mm(3) for infants aged 28 days or younger and greater than or equal to 10 cells/mm(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.

DOI10.1016/j.annemergmed.2016.10.008
Alternate JournalAnn Emerg Med
PubMed ID28041826