title: The effectiveness of lumbar puncture in the evaluation of delirium and fever in the hospitalized elderly.
abstract: OBJECTIVE
  To determine the value of the cerebrospinal fluid examination in the evaluation of hospitalized; elderly patients with delirium and fever.
  
  
  METHODS
  A retrospective case series of consecutive events during a 15-month period.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Elderly patients admitted to the University of Cincinnati (Ohio) Hospital between July 1, 1988, and October 1, 1989, who had a lumbar puncture and cerebrospinal fluid evaluation to evaluate fever and mental status changes.
  
  
  METHODS
  Primary intracranial causes and the clinical characteristics of delirium and fever.
  
  
  RESULTS
  Eighty-one hospital admissions were reviewed. Fifty-seven (70%) of the lumbar punctures were performed as part of the admitting workup, and the remaining 24 (30%) were performed during the hospitalization. Eighty of the 81 cerebrospinal fluid cultures were negative for bacterial growth. The primary origins for fever and delirium included urinary tract infections (25%), pneumonia (22%), viral causes (17%), and metabolic causes/dehydration (14%). One case of bacterial meningitis was diagnosed in an alcoholic, 73-year-old man who was unresponsive in the emergency department. One case of presumed aseptic meningitis was diagnosed in a 65-year-old man who presented with fever and headaches and a blood pressure of 230/100 mm Hg.
  
  
  CONCLUSIONS
  Most hospitalized, older patients with fever and delirium have primary causes of the confusion outside the central nervous system and may not require a routine evaluation of their cerebrospinal fluid.
authors.affiliation: Department of Family Medicine, University of Cincinnati Ohio Medical Center.
authors.forename: G
authors.initials: G
authors.lastname: Warshaw
authors.forename: F
authors.initials: F
authors.lastname: Tanzer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003221:Confusion / Q000097:blood / Q000134:cerebrospinal fluid / Q000652:urine; D003693:Delirium / Q000097:blood / Q000134:cerebrospinal fluid* / Q000652:urine; D003937:Diagnosis, Differential; D001068:Feeding and Eating Disorders / Q000503:physiopathology; D005260:Female; D005334:Fever / Q000097:blood / Q000134:cerebrospinal fluid* / Q000652:urine; D006760:Hospitalization; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid; D008584:Meningitis, Listeria / Q000134:cerebrospinal fluid; D011014:Pneumonia / Q000175:diagnosis; D012189:Retrospective Studies; D012894:Sleep Stages; D013129:Spinal Puncture; D014552:Urinary Tract Infections / Q000175:diagnosis; D014883:Water-Electrolyte Imbalance / Q000097:blood