New insights into the glucose oxidase stick test for cerebrospinal fluid rhinorrhoea

Rhinorrhoea is a clinical sign of cerebrospinal fluid (CSF) leakage in patients with skull fracture, but can also be attributable to respiratory secretions or tears. Laboratory tests confirming the presence of CSF are not sufficiently rapid to support clinical decision making in the emergency depart...

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Bibliographic Details
Published in:Emergency medicine journal : EMJ 2005-08, Vol.22 (8), p.556-557
Main Authors: Baker, E H, Wood, D M, Brennan, A L, Baines, D L, Philips, B J
Format: Article
Language:English
Subjects:
Algorithms
Blood Glucose - analysis
cerebrospinal fluid
Cerebrospinal Fluid Rhinorrhea - cerebrospinal fluid
Cerebrospinal Fluid Rhinorrhea - diagnosis
Cerebrospinal Fluid Rhinorrhea - etiology
Craniocerebral Trauma - complications
CSF
Decision making
Fractures
Glucose
Glucose - cerebrospinal fluid
Glucose Oxidase
Head injuries
Humans
hyperglycaemia
Hypoglycemia
inflammation
Meningitis
Mucus - chemistry
Reagent Strips
rhinorrhoea
Short Report
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Description
Summary:Rhinorrhoea is a clinical sign of cerebrospinal fluid (CSF) leakage in patients with skull fracture, but can also be attributable to respiratory secretions or tears. Laboratory tests confirming the presence of CSF are not sufficiently rapid to support clinical decision making in the emergency department and may not be universally available. Detection of glucose in nasal discharge was traditionally used to diagnose CSF leak at the bedside, but has fallen into disuse as it has poor positive predictive value. We propose an algorithm to improve the diagnostic value of this test taking into consideration factors we have found to affect the glucose concentration of respiratory secretions. In patients at risk of CSF leak, nasal discharge is likely to contain CSF if glucose is present in the absence of visible blood, if blood glucose is
ISSN:1472-0205
1472-0213
DOI:10.1136/emj.2004.022111