The Effect of Traumatic Lumbar Puncture on Hospitalization Rate for Febrile Infants 28 to 60 Days of Age

• Published in: Academic emergency medicine 2015-02, Vol.22 (2), p.240-243
• Main Authors: Pingree, Elizabeth W., Kimia, Amir A., Nigrovic, Lise E., Alpern, Elizabeth
• Format: Article
• Language: English
• Subjects: Babies; Bacterial Infections - cerebrospinal fluid; Bacterial Infections - diagnosis; Blood Cell Count; Boston; Cross-Sectional Studies; Effects; Emergency Service, Hospital - statistics & numerical data; Female; Fever; Hospitalization; Hospitalization - statistics & numerical data; Humans; Infant; Medical procedures; Retrospective Studies; Risk Factors; Spinal Puncture - statistics & numerical data
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/acem.12582

Objectives The authors measured the effect of a traumatic or unsuccessful lumbar puncture (LP) on the management of febrile infants. Methods This was a 10‐year retrospective cross‐sectional study of low‐risk infants by the “Boston” criteria 28 to 60 days of age presenting to the emergency department for evaluation of fever. “Normal LP” infants had cerebrospinal fluid (CSF) WBC < 10 × 106 cells/L. “Traumatic” or “unsuccessful LP” infants had CSF red blood cell count ≥ 10 × 109 cells/L or no CSF cell counts obtained, respectively. A serious bacterial infection (SBI) was defined as growth of a bacterial pathogen from culture. The hospitalization and SBI rates were compared between infants with normal versus traumatic or unsuccessful LPs. Results Of the 929 study infants, 756 (81.4%) had normal LPs, and 173 (18.6%) had traumatic or unsuccessful LPs. Infants with traumatic or unsuccessful LPs had a higher hospitalization rate (72.3% traumatic or unsuccessful LP vs. 18.1% normal LP; difference = 54.1%; 95% confidence interval [CI] = 46.4% to 60.8%), but a similar SBI rate (2.9% vs. 4.1%; difference = 1.2%; 95% CI = –2.7% to 3.6%). No infant had proven bacterial meningitis (0% risk, 95% CI = 0 to 0.3%). Conclusions Low‐risk infants aged 28 to 60 days with traumatic or unsuccessful LPs are more frequently hospitalized, although SBI rates were similar to those of infants with normal LPs.