Lyons Todd W, Cruz Andrea T, Freedman Stephen B, Neuman Mark I, Balamuth Fran, Mistry Rakesh D, Mahajan Prashant, Aronson Paul L, Thomson Joanna E, Pruitt Christopher M, Shah Samir S, Nigrovic Lise E
Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, TX.
Ann Emerg Med. 2017 May;69(5):622-631. doi: 10.1016/j.annemergmed.2016.10.008. Epub 2016 Dec 29.
We determine the optimal correction factor for cerebrospinal fluid WBC counts in infants with traumatic lumbar punctures.
We performed a secondary analysis of a retrospective cohort of infants aged 60 days or younger and with a traumatic lumbar puncture (cerebrospinal fluid RBC count ≥10,000 cells/mm) at 20 participating centers. Cerebrospinal fluid pleocytosis was defined as a cerebrospinal fluid WBC count greater than or equal to 20 cells/mm for infants aged 28 days or younger and greater than or equal to 10 cells/mm for infants aged 29 to 60 days; bacterial meningitis was defined as growth of pathogenic bacteria from cerebrospinal fluid culture. Using linear regression, we derived a cerebrospinal fluid WBC correction factor and compared the uncorrected with the corrected cerebrospinal fluid WBC count for the detection of bacterial meningitis.
Of the eligible 20,319 lumbar punctures, 2,880 (14%) were traumatic, and 33 of these patients (1.1%) had bacterial meningitis. The derived cerebrospinal fluid RBCs:WBCs ratio was 877:1 (95% confidence interval [CI] 805 to 961:1). Compared with the uncorrected cerebrospinal fluid WBC count, the corrected one had lower sensitivity for bacterial meningitis (88% uncorrected versus 67% corrected; difference 21%; 95% CI 10% to 37%) but resulted in fewer infants with cerebrospinal fluid pleocytosis (78% uncorrected versus 33% corrected; difference 45%; 95% CI 43% to 47%). Cerebrospinal fluid WBC count correction resulted in the misclassification of 7 additional infants with bacterial meningitis, who were misclassified as not having cerebrospinal fluid pleocytosis; only 1 of these infants was older than 28 days.
Correction of the cerebrospinal fluid WBC count substantially reduced the number of infants with cerebrospinal fluid pleocytosis while misclassifying only 1 infant with bacterial meningitis of those aged 29 to 60 days.
我们确定了创伤性腰椎穿刺婴儿脑脊液白细胞计数的最佳校正因子。
我们对20个参与中心的60日龄及以下且有创伤性腰椎穿刺（脑脊液红细胞计数≥10,000个/mm）的婴儿回顾性队列进行了二次分析。脑脊液细胞增多症定义为28日龄及以下婴儿脑脊液白细胞计数大于或等于20个/mm，29至60日龄婴儿脑脊液白细胞计数大于或等于10个/mm；细菌性脑膜炎定义为脑脊液培养中病原菌生长。使用线性回归，我们得出了脑脊液白细胞校正因子，并比较了未校正和校正后的脑脊液白细胞计数对细菌性脑膜炎的检测情况。
在符合条件的20,319次腰椎穿刺中，2,880次（14%）为创伤性穿刺，其中33例患者（1.1%）患有细菌性脑膜炎。得出的脑脊液红细胞与白细胞比值为877:1（95%置信区间[CI]805至961:1）。与未校正的脑脊液白细胞计数相比，校正后的脑脊液白细胞计数对细菌性脑膜炎的敏感性较低（未校正为88%，校正后为67%；差异21%；95%CI 10%至37%），但脑脊液细胞增多症的婴儿数量减少（未校正为78%，校正后为33%；差异45%；95%CI 43%至47%）。脑脊液白细胞计数校正导致另外7例细菌性脑膜炎婴儿被错误分类，他们被错误分类为没有脑脊液细胞增多症；这些婴儿中只有1例年龄大于28天。
脑脊液白细胞计数的校正显著减少了脑脊液细胞增多症婴儿的数量，同时在29至60日龄的细菌性脑膜炎婴儿中仅错误分类了1例。
