The Champagne Tap: Time to Pop the Cork?

Abstract

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. We performed a secondary analysis of a retrospective cross-sectional study of infants ≤60days 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 0cells/mm3 regardless of CSF WBC count or both CSF RBC and WBC counts of 0cells/mm3 . 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 0cells/mm3 and 377 (1.6%) had both CSF WBC and RBC counts of 0cells/mm3 (relative rate 8.35, 95% confidence interval 7.51 to 9.27). In infants, a lumbar puncture with a CSF RBC count of 0cells/mm3 regardless of the CSF WBC count occurred eight-times more frequently than one with both CSF WBC and RBC counts of 0cells/mm3 . 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.