Title: Traumatic Lumbar Punctures in Infants 1 to 2 months<br/>Author: Jennifer Guyther<br/><a href='http://umem.org/profiles/faculty/314/'>[Click to email author]</a><hr/><p>
<span style="font-family: arial, sans-serif; font-size: small;">Approximately ¼ of lumbar punctures (LP) are traumatic or </span><span style="font-family: arial, sans-serif; font-size: small;">unsuccessful in infants. What is the implication of this?</span></p>
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<span style="font-family: arial, sans-serif; font-size: small;">A retrospective cross sectional study over a 10 year period at Boston </span><span style="font-family: arial, sans-serif; font-size: small;">Children’s Hospital looked at infants aged 28 to 60 days who had blood </span><span style="font-family: arial, sans-serif; font-size: small;">cultures sent from the Emergency Department and who had LPs performed. </span><span style="font-family: arial, sans-serif; font-size: small;">The ED clinicians at this facility routinely follow the “Boston </span><span style="font-family: arial, sans-serif; font-size: small;">Criteria” to identify infants at low risk for spontaneous bacterial </span><span style="font-family: arial, sans-serif; font-size: small;">infection (SBI). Traumatic LPs were defined as CSF red cell count </span><span style="font-family: arial, sans-serif; font-size: small;">greater than or equal to 10x10^9 cells/L while an unsuccessful LP was </span><span style="font-family: arial, sans-serif; font-size: small;">defined as one where no CSF was available for cell counts. A small </span><span style="font-family: arial, sans-serif; font-size: small;">portion of the unsuccessful LPs did not have CSF cultures sent.</span></p>
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<span style="font-family: arial, sans-serif; font-size: small;">173 infants had traumatic or unsuccessful LPs. The SBI rate did not </span><span style="font-family: arial, sans-serif; font-size: small;">differ between the normal LP and the traumatic and unsuccessful LP </span><span style="font-family: arial, sans-serif; font-size: small;">infants. Median hospital charges were higher in the traumatic or </span><span style="font-family: arial, sans-serif; font-size: small;">unsuccessful LPs compared to the normal LP group ($ 5117 US dollars </span><span style="font-family: arial, sans-serif; font-size: small;">versus $ 2083 US dollars).</span></p>
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<span style="font-family: arial, sans-serif; font-size: small;"><strong>Bottom Line:</strong> Traumatic or unsuccessful LPs lead to higher hospital charges.</span></p>
<fieldset><legend>References</legend>
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<span style="font-family: arial, sans-serif; font-size: small;">Pingree EW, Kimia, AA and Nigrovic LE. The Effect of Traumatic Lumbar </span><span style="font-family: arial, sans-serif; font-size: small;">Puncture on Hospitalization Rate for Febrile Infants 28 to 60 Days of </span><span style="font-family: arial, sans-serif; font-size: small;">Age. Academic Emergency Medicine 2015; 22: 240-243.</span></p>
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