title: Variation in lumbar punctures for early onset neonatal sepsis: a nationally representative serial cross-sectional analysis, 2003-2009.
abstract: BACKGROUND
  Whether lumbar punctures (LPs) should be performed routinely for term newborns suspected of having early onset neonatal sepsis (EONS) is subject to debate. It is unclear whether variations in performance of LPs for EONS may be associated with patient, hospital, insurance or regional factors. Our objective was to identify characteristics associated with the practice of performing LPs for suspected EONS in a nationally representative sample.
  
  
  METHODS
  Utilizing data from the 2003, 2006 and 2009 Kids' Inpatient Database (KID) compiled by the Agency for Healthcare Research and Quality, we examined the frequency and characteristics of term, normal-birth weight newborns receiving an LP for EONS. Survey-weighting was applied for national estimates and used in chi squared and multivariable regression analysis.
  
  
  RESULTS
  In 2009, there were 13,694 discharges for term newborns that underwent LPs for apparent EONS. Newborns having LPs performed were more likely to be covered by Medicaid vs. private insurance (51.9 vs. 45.1 percent; p < 0.001), be born in urban vs. rural hospitals (94.8 vs. 87.3 percent; p < 0.001), teaching vs. non-teaching (60.8 vs. 43.1 percent; p < 0.001) and children's hospitals vs. non-children's (23.0 vs. 11.2 percent; p < 0.001). Lastly, newborns having LPs performed were disproportionately born in the Northeast census region (p = 0.03). In multi-year adjusted analysis, infants with Medicaid coverage, and those born in urban or teaching hospitals, consistently had higher odds of having an LP performed.
  
  
  CONCLUSIONS
  We found pronounced variation in LPs performed for EONS, even when adjusting for clinical conditions that would prompt LPs. These findings indicate practice variations in newborn care that merit further examination and explanation.
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan 48109, USA. stepatri@med.umich.edu
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Patrick
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schumacher
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
mesh_terms: D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D019538:Health Care Surveys; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000175:diagnosis; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018805:Sepsis / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D013129:Spinal Puncture / Q000706:statistics & numerical data*; D014481:United States