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

Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus Study Group

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)622-631
Number of pages10
JournalAnnals of Emergency Medicine
Volume69
Issue number5
DOIs
StatePublished - May 1 2017

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Spinal Puncture
Leukocyte Count
Cerebrospinal Fluid
Bacterial Meningitides
Leukocytosis
Confidence Intervals
Linear Models

ASJC Scopus subject areas

  • Emergency Medicine

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Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus Study Group (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

Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture. / Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus Study Group.

In: Annals of Emergency Medicine, Vol. 69, No. 5, 01.05.2017, p. 622-631.

Research output: Contribution to journalArticle

Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus Study Group 2017, 'Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture', Annals of Emergency Medicine, vol. 69, no. 5, pp. 622-631. https://doi.org/10.1016/j.annemergmed.2016.10.008
Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus Study Group. Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture. Annals of Emergency Medicine. 2017 May 1;69(5):622-631. https://doi.org/10.1016/j.annemergmed.2016.10.008
Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus Study Group. / Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture. In: Annals of Emergency Medicine. 2017 ; Vol. 69, No. 5. pp. 622-631.
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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.",
author = "{Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus Study Group} and Lyons, {Todd W.} and Cruz, {Andrea T.} and Freedman, {Stephen B.} and Neuman, {Mark I.} and Fran Balamuth and Mistry, {Rakesh D.} and Prashant Mahajan and Aronson, {Paul L.} and Thomson, {Joanna E.} and Pruitt, {Christopher M.} and Shah, {Samir S.} and Nigrovic, {Lise E.} and Dina Kulik and Okada, {Pamela J.} and Fleming, {Alesia H.} and Arms, {Joseph L.} and Garro, {Aris C.} and Uspal, {Neil G.} and Thompson, {Amy D.} and Ishimine, {Paul T.} and Alpern, {Elizabeth R.} and Grether-Jones, {Kendra L.} and Miller, {Aaron S.} and Jeffrey Louie and David Schandower and Curtis, {Sarah J.} and Schmidt, {Suzanne M.} and Bradin, {Stuart A.}",
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AU - Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus Study Group

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 - Kulik, Dina

AU - Okada, Pamela J.

AU - Fleming, Alesia H.

AU - Arms, Joseph L.

AU - Garro, Aris C.

AU - Uspal, Neil G.

AU - Thompson, Amy D.

AU - Ishimine, Paul T.

AU - Alpern, Elizabeth R.

AU - Grether-Jones, Kendra L.

AU - Miller, Aaron S.

AU - Louie, Jeffrey

AU - Schandower, David

AU - Curtis, Sarah J.

AU - Schmidt, Suzanne M.

AU - Bradin, Stuart A.

PY - 2017/5/1

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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.

AB - 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.

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