The effect of traumatic lumbar puncture on hospitalization rate for febrile infants 28 to 60 days of age

Abstract

Objectives The authors measured the effect of a traumatic or unsuccessful lumbar puncture (LP) on the management of febrile infants. Methods This was a 10-year retrospective cross-sectional study of low-risk infants by the "Boston" criteria 28 to 60 days of age presenting to the emergency department for evaluation of fever. "Normal LP" infants had cerebrospinal fluid (CSF) WBC < 10 × 106 cells/L. "Traumatic" or "unsuccessful LP" infants had CSF red blood cell count ≥ 10 × 109 cells/L or no CSF cell counts obtained, respectively. A serious bacterial infection (SBI) was defined as growth of a bacterial pathogen from culture. The hospitalization and SBI rates were compared between infants with normal versus traumatic or unsuccessful LPs. Results Of the 929 study infants, 756 (81.4%) had normal LPs, and 173 (18.6%) had traumatic or unsuccessful LPs. Infants with traumatic or unsuccessful LPs had a higher hospitalization rate (72.3% traumatic or unsuccessful LP vs. 18.1% normal LP; difference = 54.1%; 95% confidence interval [CI] = 46.4% to 60.8%), but a similar SBI rate (2.9% vs. 4.1%; difference = 1.2%; 95% CI = -2.7% to 3.6%). No infant had proven bacterial meningitis (0% risk, 95% CI = 0 to 0.3%). Conclusions Low-risk infants aged 28 to 60 days with traumatic or unsuccessful LPs are more frequently hospitalized, although SBI rates were similar to those of infants with normal LPs.