title: New insights into the glucose oxidase stick test for cerebrospinal fluid rhinorrhoea.
abstract: Rhinorrhoea is a clinical sign of cerebrospinal fluid (CSF) leakage in patients with skull fracture, but can also be attributable to respiratory secretions or tears. Laboratory tests confirming the presence of CSF are not sufficiently rapid to support clinical decision making in the emergency department and may not be universally available. Detection of glucose in nasal discharge was traditionally used to diagnose CSF leak at the bedside, but has fallen into disuse as it has poor positive predictive value. We propose an algorithm to improve the diagnostic value of this test taking into consideration factors we have found to affect the glucose concentration of respiratory secretions. In patients at risk of CSF leak, nasal discharge is likely to contain CSF if glucose is present in the absence of visible blood, if blood glucose is <6 mmol x L(-1), and if there are no symptoms of upper respiratory tract infection.
authors.affiliation: Glucose and Pulmonary Infection Group, St George's, University of London, London, UK. ebaker@sgul.ac.uk
authors.forename: E H
authors.initials: EH
authors.lastname: Baker
authors.forename: D M
authors.initials: DM
authors.lastname: Wood
authors.forename: A L
authors.initials: AL
authors.lastname: Brennan
authors.forename: D L
authors.initials: DL
authors.lastname: Baines
authors.forename: B J
authors.initials: BJ
authors.lastname: Philips
mesh_terms: D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis; D002559:Cerebrospinal Fluid Rhinorrhea / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000209:etiology; D006259:Craniocerebral Trauma / Q000150:complications; D005947:Glucose / Q000134:cerebrospinal fluid*; D005949:Glucose Oxidase; D006801:Humans; D009093:Mucus / Q000737:chemistry; D011934:Reagent Strips
chemical_list: D001786:Blood Glucose; D011934:Reagent Strips; D005949:Glucose Oxidase; D005947:Glucose