Abstract
BackgroundThe use of the lumbar puncture in the diagnosis of central nervous system infection in acutely ill children is controversial. Recommendations have been published but it is unclear whether they are being followed.MethodsThe medical case notes of 415 acute medical admissions in a children's hospital were examined to identify children with suspected central nervous system infection and suspected meningococcal septicaemia. We determined whether lumbar punctures were indicated or contraindicated, whether they had been performed, and whether the results contributed to the patients' management.ResultsFifty-two children with suspected central nervous system infections, and 43 with suspected meningococcal septicaemia were identified. No lumbar punctures were performed in patients with contraindications, but only 25 (53%) of 47 children with suspected central nervous system infection and no contraindications received a lumbar puncture. Lumbar puncture findings contributed to the management in 18 (72%) of these patients, by identifying a causative organism or excluding bacterial meningitis.ConclusionThe recommendations for undertaking lumbar punctures in children with suspected central nervous system infection are not being followed because many children that should receive lumbar punctures are not getting them. When they are performed, lumbar puncture findings make a useful contribution to the patients' management.
Highlights
The use of the lumbar puncture in the diagnosis of central nervous system infection in acutely ill children is controversial
BMC Pediatrics 2002, 2 http://www.biomedcentral.com/1471-2431/2/8 ever, the role of the lumbar puncture (LP) has been questioned again recently because of the suggestion that, since the arrival of newer diagnostic techniques – especially the polymerase chain reaction (PCR), the LP contributes little to patient management [9]
We show that only 53% of patients that should have received an LP had one, yet in nearly three quarters of these patients it helped in the management
Summary
The use of the lumbar puncture in the diagnosis of central nervous system infection in acutely ill children is controversial. Recommendations have been published but it is unclear whether they are being followed. The use of the lumbar puncture (LP) in the diagnosis of central nervous system (CNS) infection in children is controversial [1,2,3]. The causal association between LP and cerebral herniation remains unproven, recommendations were published as to which patients should and should not receive a LP [1,2,8]. The purpose of this study was to determine whether the recommendations for LP are being followed, and whether the CSF findings obtained contributed to patients' management. We show that only 53% of patients that should have received an LP had one, yet in nearly three quarters of these patients it helped in the management
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