Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre RS, Brazil; Graduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre RS, Brazil.
Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre RS, Brazil.
World Neurosurg. 2020 Jun;138:e683-e689. doi: 10.1016/j.wneu.2020.03.045. Epub 2020 Mar 16.
Patients harboring an external ventricular drain (EVD) who develop signs of infection require screening for infection in the central nervous system (CNS). The cerebrospinal fluid (CSF) can be collected by the EVD or by lumbar puncture (LP). If only one sample is analyzed, the diagnosis might be dubious or false-negative. The objective of this study was to compare the diagnosis accuracy of CNS infection of CSF samples collected from EVD and LP.
We conducted a transversal study where data were prospectively collected from 2016 to 2019. Patients harboring EVD with signs of infection were submitted to the CSF analysis collected by LP and EVD. Diagnosis sensibility and results correlation were analyzed using the kappa index.
The 141 samples from LP and 141 samples from EVD were collected from 108 patients. Among the 282 samples, a total of 77 had infection. Seventy CSF samples from LP fulfilled infection criteria. However, only 32 EVD samples demonstrated infection. Among the 70 cases of infection based on the LP sample, 25 CSF samples collected from the EVD were also suggestive of infection; but in 45 patients only the CSF samples from LP met infection criteria. Seven patients had diagnosis of infection only in the EVD sample. The kappa correlation index of the results obtained from LP and EVD was 0.260 and the McNemar χ test was <0.01.
The CSF analysis exclusive from the EVD has a low sensibility and negative predictive value. CSF collected from LP has a sensibility 2.18 times higher than EVD.
患有外部脑室引流管（EVD）并出现感染迹象的患者需要筛查中枢神经系统（CNS）感染。脑脊液（CSF）可通过 EVD 或腰椎穿刺（LP）采集。如果仅分析一个样本，则诊断可能存在疑问或为假阴性。本研究的目的是比较通过 EVD 和 LP 采集的 CSF 样本对 CNS 感染的诊断准确性。
我们进行了一项横断面研究，从 2016 年至 2019 年前瞻性收集数据。有 EVD 并出现感染迹象的患者接受 LP 和 EVD 采集的 CSF 分析。使用 Kappa 指数分析诊断敏感性和结果相关性。
从 108 名患者中采集了 141 份 LP 样本和 141 份 EVD 样本。在 282 份样本中，共有 77 份存在感染。70 份 LP 样本符合感染标准，但只有 32 份 EVD 样本显示感染。在基于 LP 样本的 70 例感染病例中，有 25 份 EVD 采集的 CSF 样本也提示感染，但在 45 例患者中，只有 LP 的 CSF 样本符合感染标准。7 例患者仅在 EVD 样本中诊断为感染。LP 和 EVD 结果的 Kappa 相关指数为 0.260，McNemar χ 检验<0.01。
仅从 EVD 分析 CSF 的敏感性和阴性预测值较低。LP 采集的 CSF 敏感性比 EVD 高 2.18 倍。
