UMEM Educational Pearls

Category: Pediatrics

Title: Traumatic Lumbar Punctures in Infants 1 to 2 months

Keywords: Traumatic lumbar punctures, fever, infants (PubMed Search)

Posted: 4/17/2015 by Jennifer Guyther, MD
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Approximately ¼ of lumbar punctures (LP) are traumatic or unsuccessful in infants.  What is the implication of this?


A retrospective cross sectional study over a 10 year period at Boston Children’s Hospital looked at infants aged 28 to 60 days who had blood cultures sent from the Emergency Department and who had LPs performed. The ED clinicians at this facility routinely follow the “Boston Criteria” to identify infants at low risk for spontaneous bacterial infection (SBI).  Traumatic LPs were defined as CSF red cell count greater than or equal to 10x10^9 cells/L while an unsuccessful LP was defined as one where no CSF was available for cell counts.  A small portion of the unsuccessful LPs did not have CSF cultures sent.


173 infants had traumatic or unsuccessful LPs.  The SBI rate did not differ between the normal LP and the traumatic and unsuccessful LP infants.  Median hospital charges were higher in the traumatic or unsuccessful LPs compared to the normal LP group ($ 5117 US dollars versus $ 2083 US dollars).


Bottom Line:  Traumatic or unsuccessful LPs lead to higher hospital charges.

References

Pingree EW, Kimia, AA and Nigrovic LE.  The Effect of Traumatic Lumbar Puncture on Hospitalization Rate for Febrile Infants 28 to 60 Days of Age. Academic Emergency Medicine 2015; 22: 240-243.