Uses and Technique of Pediatric Lumbar Puncture

Ward, Em; Gushurst, Colette

doi:10.1001/archpedi.1992.02160220046019

Cited by 8 publications

(9 citation statements)

References 93 publications

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“…Proposals have been made to perform laboratory testing on CSF in a logical sequence, relying on standard tests such as cell count, differential, protein and glucose concentrations, and Gram staining to guide the decision to order additional testing (10,19,25,27,29). The cell count and differential in CSF have been shown to be sensitive indicators of bacterial meningitis, more so than glucose and protein concentration estimations, which are often nonspecific and of limited diagnostic value (13,19,29,(34)(35)(36). Using a WBC count of Ն50 cells per mm 3 as a criterion for performing BAT, Werner and Kruger (36) achieved 100% sensitivity in predicting BA-positive specimens (36).…”

Section: Discussionmentioning

confidence: 99%

Quality assurance study of bacterial antigen testing of cerebrospinal fluid

Kiska¹,

Jones²,

Mangum³

et al. 1995

J Clin Microbiol

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Bacterial antigen testing (BAT) of cerebrospinal fluid (CSF) by latex agglutination is a low-yield procedure in patients whose CSF specimens have normal laboratory parameters. Between August 1992 and August 1994, we evaluated 287 bacterial antigen (BA) test requests to determine whether yields could be improved and whether patient costs could be reduced by canceling BAT for those patients with normal CSF parameters (cell count, protein, glucose) after consultation with physicians. A total of 171 (68%) BA tests were canceled by this approach. None of these CSF specimens was culture positive for an organism detectable by BAT. Of the remaining 116 CSF specimens tested, only 3 were positive by BAT, one each for Neisseria meningitidis, Streptococcus pneumoniae, and group B streptococcus. Only 43 of the CSF specimens tested had at least two abnormal parameters; the 3 positive CSF specimens were included in this group. In light of the low rate of positivity, the number of BA tests can be further reduced by establishing criteria that must be met before a CSF specimen is accepted for BAT. After review of our data and the literature concerning this topic, we concluded that only specimens with leukocyte counts of Ն50 cells per mm 3 should be tested. Of 287 specimens evaluated in our study, only 36 met this criterion, including the 3 BA-positive specimens. Enacting such a restriction would have reduced the total number of BA tests by 251 (87%) without compromising patient care. A laboratory cost savings of $6,500 per year would have been realized, with a substantial reduction in the cost per positive test. Patient charges would have been reduced by $12,500 per year.

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Section: Discussionmentioning

confidence: 99%

Quality assurance study of bacterial antigen testing of cerebrospinal fluid

Kiska¹,

Jones²,

Mangum³

et al. 1995

J Clin Microbiol

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“…In patients who have been partially treated with antibiotics or who are immunosuppressed, the clinical features of meningitis may be more subtle and there should be a lower threshold for performing LP in this group 8 . Lumbar puncture is often used as a test of exclusion in the presence of febrile seizures in children, and fever and delirium in the elderly; although the diagnostic yield in these situations is low in the absence of other supportive clinical parameters 9–15 …”

Section: Indicationsmentioning

confidence: 99%

“…However, antibiotic therapy should not be withheld once the diagnosis is clinically suspected as the organism may still be identified in the CSF or by blood culture and CSF antigen testing 24–26 . The classical findings of high protein, low glucose and neutrophil pleocytosis will often persist for several days 13,24,25,60–62 …”

Section: Csf Interpretationmentioning

confidence: 99%

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Perils and pitfalls of lumbar puncture in the emergency department

Cuthbert

2001

Emergency Medicine

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Lumbar Puncture is a procedure commonly performed in the emergency department. It provides important diagnostic information but has a significant number of limitations and complications. This article reviews the role of lumbar puncture in the emergency department based on an extensive review of the current literature, focusing on the recognized contraindications and complications of the procedure and how they can be minimized. The interpretation of diagnostic tests performed on cerebrospinal fluid is also examined, highlighting those tests most commonly ordered from the emergency department.

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“…Although LP in children was initially described in 1878, 1 we are unaware of any studies which explain physicians' training, preferred techniques, and use of analgesics in this patient population. Although LP in children was initially described in 1878, 1 we are unaware of any studies which explain physicians' training, preferred techniques, and use of analgesics in this patient population.…”

mentioning

confidence: 99%