Shah Kaushal H, Richard Kathleen M, Nicholas Sarah, Edlow Jonathan A
Beth Israel Deaconess Medical Center, Harvard Affiliated Emergency Medicine Residency, Harvard Medical School, Boston, MA 02215, USA.
Acad Emerg Med. 2003 Feb;10(2):151-4. doi: 10.1111/j.1553-2712.2003.tb00033.x.
To determine the incidence of traumatic lumbar puncture (LP).
A retrospective study was conducted at an urban, university tertiary care referral center with 50000 annual emergency department (ED) visits. The study population included all patients who had cerebrospinal fluid (CSF) samples sent to the laboratory between August 15, 2000, and August 14, 2001. The numbers of red blood cells (RBCs) recorded in the first and last CSF tubes, the location where the LP was performed, and the discharge summary and the discharge diagnoses from the particular visit were obtained. All patients with intracranial pathology and CSF obtained via neurosurgical procedure or fluoroscopic guidance were excluded from the study group. Given no clear definition of traumatic LP in the literature, the incidence of traumatic LP was calculated using a cutoff of greater than 400 RBCs (visual threshold for bloody fluid) and 1000 RBCs (arbitrary threshold selected by other authors) in CSF tube 1. Proportions were compared using chi-square statistics.
Seven hundred eighty-six CSF samples were recorded over one year. Twenty-four samples were obtained from patients with intracranial pathology or were obtained via a neurosurgical procedure. Of the remaining 762 CSF samples in the study population, 119 (15.6%) were traumatic using a cutoff of 400 RBCs, and 80 (10.5%) were traumatic, using a cutoff of 1000 RBCs in tube 1. Five hundred three LPs were done in the ED and 259 were attributed to all other locations in the hospital. Using a cutoff of 400 RBCs, the incidence of traumatic LP in the ED was 13.3%, compared with 20% in the rest of the hospital (p < 0.025). Similarly, using a cutoff of 1000 RBCs, the incidence of traumatic LP in the ED was 8.9%, compared with 13.5% in the rest of the hospital (p = 0.1). The incidence of "champagne taps" (defined as zero RBCs in the first and last tubes) in the ED was 34.4%, compared with 24.3% in the rest of the hospital (p < 0.01).
The incidence of traumatic lumbar puncture is approximately 15% using a cutoff of 400 RBCs and 10% using a cutoff of 1000 RBCs. In this study, the rate of traumatic lumbar puncture was significantly less (with a cutoff of 400 RBCs) and the rate of champagne tap was significantly greater for LPs done in the ED compared with the rest of the hospital.
确定创伤性腰椎穿刺（LP）的发生率。
在一所城市大学三级医疗转诊中心进行了一项回顾性研究，该中心每年有50000人次急诊就诊。研究人群包括2000年8月15日至2001年8月14日期间所有将脑脊液（CSF）样本送检的患者。获取第一管和最后一管CSF中记录的红细胞（RBC）数量、进行LP的位置以及该次就诊的出院小结和出院诊断。所有患有颅内病变以及通过神经外科手术或透视引导获取CSF的患者均被排除在研究组之外。鉴于文献中对创伤性LP没有明确的定义，使用CSF第一管中大于400个RBC（血性液体的视觉阈值）和1000个RBC（其他作者选择的任意阈值）作为临界值来计算创伤性LP的发生率。使用卡方统计比较比例。
一年中记录了786份CSF样本。24份样本来自患有颅内病变的患者或通过神经外科手术获取。在研究人群中其余762份CSF样本中，以400个RBC为临界值时，119份（15.6%）为创伤性；以1000个RBC为临界值时，80份（10.5%）为创伤性。503次LP在急诊室进行，259次归因于医院的所有其他地点。以400个RBC为临界值时，急诊室创伤性LP的发生率为13.3%，而医院其他地方为20%（p<0.025）。同样，以1000个RBC为临界值时，急诊室创伤性LP的发生率为8.9%，而医院其他地方为13.5%（p=0.1）。急诊室“香槟穿刺”（定义为第一管和最后一管中RBC为零）的发生率为34.4%，而医院其他地方为24.3%（p<0.01）。
以400个RBC为临界值时，创伤性腰椎穿刺的发生率约为15%；以1000个RBC为临界值时，发生率约为10%。在本研究中，与医院其他地方相比，急诊室进行的LP创伤性腰椎穿刺率显著更低（以400个RBC为临界值），而“香槟穿刺”率显著更高。
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