From, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
the, Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, TX.
Acad Emerg Med. 2020 Nov;27(11):1194-1198. doi: 10.1111/acem.13966. Epub 2020 Apr 20.
A "champagne tap" is a lumbar puncture with no cerebrospinal fluid (CSF) red blood cells (RBCs). Clinicians disagree whether the absence of CSF white blood cells (WBCs) is also required.
As supervising providers frequently reward trainees after a champagne tap, we investigated how varying the definition impacted the frequency of trainee accolades.
MATERIALS & METHODS: We performed a secondary analysis of a retrospective cross-sectional study of infants ≤60 days of age who had a CSF culture performed in the emergency department (ED) at one of 20 centers participating in a Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) endorsed study. Our primary outcomes were a champagne tap defined by either a CSF RBC count of 0 cells/mm regardless of CSF WBC count or both CSF RBC and WBC counts of 0 cells/mm .
Of the 23,618 eligible encounters, 20,358 (86.2%) had both a CSF RBC and WBC count obtained. Overall, 3,147 (13.3%) had a CSF RBC count of 0 cells/mm and 377 (1.6%) had both CSF WBC and RBC counts of 0 cells/mm (relative rate 8.35, 95% confidence interval 7.51 to 9.27).
In infants, a lumbar puncture with a CSF RBC count of 0 cells/mm regardless of the CSF WBC count occurred eight-times more frequently than one with both CSF WBC and RBC counts of 0 cells/mm . A broader champagne tap definition would allow more frequent recognition of procedural success, with the potential to foster a supportive community during medical training, potentially protecting against burnout.
“香槟穿刺”是指腰椎穿刺时没有脑脊液（CSF）中的红细胞（RBC）。临床医生对是否也需要没有 CSF 白细胞（WBC）存在存在分歧。
由于上级医生通常会在进行“香槟穿刺”后奖励受训者，因此我们研究了改变定义对受训者获得认可的频率的影响。
我们对 20 个参与小儿急诊医学合作研究委员会（PEM CRC）认可研究的中心之一的急诊科进行的一项回顾性横断面研究进行了二次分析，该研究纳入了≤60 天龄的婴儿，对其进行了 CSF 培养。我们的主要结局是通过 CSF RBC 计数为 0 个细胞/mm，无论 CSF WBC 计数如何，或 CSF RBC 和 WBC 计数均为 0 个细胞/mm 来定义“香槟穿刺”。
在 23618 例符合条件的就诊中，有 20358 例（86.2%）同时获得了 CSF RBC 和 WBC 计数。总体而言，3147 例（13.3%）的 CSF RBC 计数为 0 个细胞/mm，377 例（1.6%）的 CSF RBC 和 WBC 计数均为 0 个细胞/mm（相对比率为 8.35，95%置信区间为 7.51 至 9.27）。
在婴儿中，CSF RBC 计数为 0 个细胞/mm，无论 CSF WBC 计数如何，发生的频率是 CSF RBC 和 WBC 计数均为 0 个细胞/mm 的八倍。更广泛的香槟穿刺定义将允许更频繁地识别程序成功，这有可能在医学培训期间培养一个支持性的社区，从而有可能防止倦怠。
