Lumbar Puncture for All Febrile Infants 29-56 Days Old: A Retrospective Cohort Reassessment Study

The Journal of Pediatrics
Richard ScarfoneFran Balamuth

Abstract

To determine the incidence of bacterial meningitis (BM) among all febrile infants 29-56 days old undergoing a lumbar puncture (LP) in the emergency department of a tertiary care children's hospital and the number of low-risk febrile infants with BM to reassess the need for routine LP in these infants. Retrospective cohort study using a quality improvement registry from July 2007-April 2014. Infants included were 29-56 days old with fever and who had an LP in the emergency department. Low-risk criteria were adapted from the Philadelphia criteria. BM was defined as having a bacterial pathogen isolated from the cerebrospinal fluid. A medical record review of one-third of randomly selected patients in the cohort determined the proportion who met low-risk criteria. One of 1188 febrile infants (0.08%) had BM; this patient did not meet low-risk criteria. An additional 40 (3.4%) had positive cerebrospinal fluid cultures; all were contaminants. Subanalysis of one-third of the study population revealed that 45.6% met low-risk criteria; the most common reasons for failing low-risk classification included abnormal white blood cell count or urinalysis. In a cohort of febrile infants, BM is uncommon and no cases of BM would have been missed ...Continue Reading

Citations

Mar 24, 2018·Hospital Pediatrics·Thomas J Lee, Paul L Aronson
Feb 19, 2019·JAMA Pediatrics·Nathan KuppermannUNKNOWN Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)
Apr 23, 2020·Journal of the Pediatric Infectious Diseases Society·Matthew J KanTara L Greenhow
Jun 12, 2018·Journal of the American Medical Informatics Association : JAMIA·Russell J McCullohJason G Newland
Nov 27, 2020·Hospital Pediatrics·Lyubina C YankovaPaul L Aronson
Mar 15, 2021·Journal of Emergency Nursing : JEN : Official Publication of the Emergency Department Nurses Association·Ashley DunawayCarrese Stevens
Nov 2, 2020·The Journal of Pediatrics·Courtney CoyleJulie C Leonard
Jul 17, 2021·Pediatric Emergency Care·Payal K GalaFran Balamuth
Nov 15, 2018·Pediatrics·Paul L AronsonUNKNOWN Febrile Young Infant Research Collaborative
Mar 25, 2020·Pediatrics·Todd W LyonsUNKNOWN HERPES SIMPLEX VIRUS STUDY GROUP OF THE PEDIATRIC EMERGENCY MEDICINE COLLABORATIVE RESEARCH COMMITTEE (PEM CRC)
Jul 21, 2021·Pediatrics·Robert H PantellUNKNOWN SUBCOMMITTEE ON FEBRILE INFANTS
Dec 9, 2020·Pediatrics·Son H McLarenUNKNOWN PEDIATRIC EMERGENCY MEDICINE COLLABORATIVE RESEARCH COMMITTEE

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