The Diagnostic Dilemma of Traumatic Lumbar Puncture: Current Standing of Cerebrospinal Fluid Leukocyte Corrections and Our Experience With Cerebrospinal Fluid Biomarkers

Nazir, Mudasir; Wani, Wasim Ahmad; Kawoosa, Khalid; Dar, Sheeraz A.; Malik, Muzaffar Ahmad; Mir, Naseer Yousuf; Ahmad, Irshad; Bhat, Rais Ahmad; Bhat, Javeed I.; Ahmad, Qazi Iqbal; Charoo, Bashir Ahmad; Ali, Syed Wajid

doi:10.1177/0883073818761719

Cited by 5 publications

(20 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, recent studies also show a higher incidence of traumatic LP in patients with a lower neonatal age [ 2 , 11 , 15 ], again in line with our results. We found no significant differences in the proportion of traumatic LPs according to sex and birth weight, also in accordance with the latest published studies [ 1 , 2 ].…”

Section: Discussionsupporting

confidence: 93%

“…Meningitis occurs most often in the first month of life and is associated with high rates of morbidity and mortality [ 1 – 3 ]. The signs and symptoms of neonatal meningitis are often nonspecific, making it difficult to decide when to perform a lumbar puncture (LP) to confirm diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…This decision becomes more complicated when the LP is traumatic, as cell counts are difficult to interpret; these patients are also generally treated for meningitis until confirmation of the diagnosis [ 8 ]. The consequences of this approach range from complications caused by the often unnecessary use of antibiotics to a longer hospital stay [ 1 , 2 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Interpretation of white blood cell counts in the cerebrospinal fluid of neonates with traumatic lumbar puncture: a retrospective cohort study

et al. 2022

View full text Add to dashboard Cite

Background Difficulty in interpreting white blood cell (WBC) counts in cerebrospinal fluid (CSF) complicates the diagnosis of neonatal meningitis in traumatic lumbar punctures (LP). The aim of our study was to determine the correction factor for WBC counts in traumatic LP that offers the greatest diagnostic efficacy in meningitis. Methods We conducted a retrospective observational study of LP in neonates between January 2014 and December 2020. Traumatic LP was defined as a red blood cell (RBC) count ≥ 1,000 cells/mm3 CSF and pleocytosis as WBCs ≥ 20 cells/mm3 CSF. The CSF RBC:WBC ratio was analyzed by linear regression to determine a new correction factor. Cell count adjustments were also studied using the 500:1, the 1,000:1 ratio method, and the peripheral blood RBC:WBC ratio, using ROC curves and studies of accuracy (sensitivity and specificity). Results Overall, 41.0% of the 1,053 LPs included in the study were traumatic. The best results for effective WBC correction were the method based on the peripheral blood ratio (sensitivity = 1.0 and specificity = 0.9 for bacterial meningitis and sensitivity = 0.8 and specificity = 0.9 for viral meningitis) and the 400:1 ratio (sensitivity = 1.0 and specificity = 0.8 for bacterial meningitis and sensitivity = 0.8 and specificity = 0.8 for viral meningitis) obtained from linear regression (95% CI 381.7–427.4; R2 = 0.7). Conclusion Both the peripheral blood correction and the 400:1 correction reduce the number of neonates classified with pleocytosis who were not eventually diagnosed with meningitis. Both methods might be a useful tool to clarify the neonatal meningitis diagnosis, offering neonatologists the possibility to assess the WBC count in traumatic LP.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Interpretation of white blood cell counts in the cerebrospinal fluid of neonates with traumatic lumbar puncture: a retrospective cohort study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Therefore, a rapid and accurate diagnosis of acute bacterial meningitis is vital to prevent the serious sequelae, and also to avoid unnecessary exposure to antibiotics or prolonged hospitalisation [4,5]. Examination of the cerebrospinal fluid (CSF) through lumbar puncture (LP) remains the gold standard method to confirm bacterial meningitis in any patient with suspected meningitis, as the clinical symptoms and signs are often nonspecific and unreliable [6,7]. Traumatic LPs however, are common in children (10-40%) and complicate the 2018.…”

Section: Introductionmentioning

confidence: 99%

“…

…”

mentioning

confidence: 99%

Cell Ratios in Traumatic Cerebrospinal Fluid. Do They Have Predictive Value for Meningitis?

Raba¹

2020

AJPN

View full text Add to dashboard Cite

clinician's ability to interpret CSF white blood cell (WBC) counts [6,8]. Although there were several methods for correction of WBC count in a traumatic LP, a CSF red to white cell correction ratio of 500:1 is the most used method for adjustment of the white cell count in traumatic CSF. The reliability of this approach to rule out bacterial meningitis remains controversial. A large retrospective study showed that adjustment of CSF WBC using 500:1 ratio does

show abstract

Meta-analysis of Cerebrospinal Fluid Cell Count and Biochemistry to Diagnose Meningitis in Infants Aged < 90 Days

et al. 2023

View full text Add to dashboard Cite

Objective Cerebrospinal fluid (CSF) white blood cell (WBC) count, protein, and glucose (cytochemistry) are performed to aid in the diagnosis of meningitis in young infants. However, studies have reported varying diagnostic accuracies. We assessed the diagnostic accuracy of CSF cytochemistry in infants below 90 days and determined the certainty of evidence. Study Design We searched PubMed, Embase, Cochrane Library, Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases in August 2021. We included studies that evaluated the diagnostic accuracy of CSF cytochemistry compared with CSF culture, Gram stain, or polymerase chain reaction in neonates and young infants <90 days with suspected meningitis. We pooled data using the hierarchical summary receiver operator characteristic (ROC) model. Results Of the 10,720 unique records, 16 studies were eligible for meta-analysis, with a cumulative sample size of 31,695 (15 studies) for WBC, 12,936 (11 studies) for protein, and 1,120 (4 studies) for glucose. The median (Q1, Q3) specificities of WBC, protein, and glucose were 87 (82, 91), 89 (81, 94), and 91% (76, 99), respectively. The pooled sensitivities (95% confidence interval [CI]) at median specificity of WBC count, protein, and glucose were 90 (88, 92), 92 (89, 94), and 71% (54, 85), respectively. The area (95% CI) under ROC curves were 0.89 (0.87, 0.90), 0.87 (0.85, 0.88), and 0.81 (0.74, 0.88) for WBC, protein, and glucose, respectively. There was an unclear/high risk of bias and applicability concern in most studies. Overall certainty of the evidence was moderate. A bivariate model-based analysis to estimate the diagnostic accuracy at specific thresholds could not be conducted due to a paucity of data. Conclusion CSF WBC and protein have good diagnostic accuracy for the diagnosis of meningitis in infants below 90 days of age. CSF glucose has good specificity but poor sensitivity. However, we could not identify enough studies to define an optimal threshold for the positivity of these tests. Key Points

show abstract

The Diagnostic Dilemma of Traumatic Lumbar Puncture: Current Standing of Cerebrospinal Fluid Leukocyte Corrections and Our Experience With Cerebrospinal Fluid Biomarkers

Abstract: Cerebrospinal fluid levels of procalcitonin, lactate, and lactate-ratio are reliable markers to diagnose bacterial meningitis in blood-contaminated cerebrospinal fluid.

Cited by 5 publications

References 29 publications

Interpretation of white blood cell counts in the cerebrospinal fluid of neonates with traumatic lumbar puncture: a retrospective cohort study

Interpretation of white blood cell counts in the cerebrospinal fluid of neonates with traumatic lumbar puncture: a retrospective cohort study

Cell Ratios in Traumatic Cerebrospinal Fluid. Do They Have Predictive Value for Meningitis?

Meta-analysis of Cerebrospinal Fluid Cell Count and Biochemistry to Diagnose Meningitis in Infants Aged < 90 Days

Contact Info

Product

Resources

About