414: A Comparison of Point of Care Cerebral Spinal Fluid Glucose Measurements With Laboratory Cerebral Spinal Fluid Glucose Measurements

Abstract

Compare glucose levels measured by bedside point of care (POC) glucometer with laboratory glucose measurements of cerebral spinal fluid (CSF) in patients undergoing lumbar puncture (LP) for diagnosis of meningitis. We enrolled eighteen adult emergency department (ED) patients who were undergoing LP. The patients were approached prior to the procedure to obtain consent. The LP was performed by the patient's emergency physician provider according to the standard method of CSF collection. After CSF collection was completed for routine testing, a single drop of CSF was placed directly from the spinal needle onto the POC glucometer test strip and the glucose level was recorded. This value was then compared to the glucose result obtained from the CSF sent to the laboratory. CSF glucose levels obtained via POC glucometer generally overestimate the actual glucose values as determined by laboratory testing. With the exception of two values that appear near the ideal line, the POC glucose level was 50% to 100% higher than the laboratory level. The goal of a POC test is to reliably diagnose a condition more quickly than the standard method of awaiting results from a laboratory. Meningitis is a condition that requires prompt diagnosis and treatment. POC testing of CSF glucose fairly consistently overestimates the actual glucose level, and would therefore lead to delayed treatment of patients who actually present with meningitis. POC glucometers cannot reliably measure glucose levels in CSF and should not be used to assist in the diagnosis of meningitis.