title: Comparing the use of, and considering the need for, lumbar puncture in children with influenza or other respiratory virus infections.
abstract: BACKGROUND
  The clinical presentation of influenza in infancy may be similar to serious bacterial infection and be investigated with invasive procedures like lumbar puncture (LP), despite very limited evidence that influenza occurs concomitantly with bacterial meningitis, perhaps because the diagnosis of influenza is very often not established when the decision to perform LP is being considered.
  
  
  METHODS
  A retrospective medical record review was undertaken in all children presenting to the Children's Hospital at Westmead, Sydney, Australia, in one winter season with laboratory-confirmed influenza or other respiratory virus infections (ORVIs) but excluding respiratory syncytial virus, to compare the use of, and reflect on the need for, the performance of invasive diagnostic procedures, principally LP, but also blood culture, in influenza and non-influenza cases. We also determined the rate of concomitant bacterial meningitis or bacteraemia.
  
  
  RESULTS
  Of 294 children, 51% had laboratory-confirmed influenza and 49% had ORVIs such as parainfluenza viruses (34%) and adenoviruses (15%). Of those with influenza, 18% had a LP and 71% had a blood culture performed compared with 6·3% and 55·5% in the ORVI group (for both P<0·01). In multivariate analysis, diagnosis of influenza was a strong independent predictor of both LP (P=0·02) and blood culture (P=0·05) being performed, and, in comparison with ORVIs, influenza cases were almost three times more likely to have a LP performed on presentation to hospital. One child with influenza (0·9%) had bacteraemia and none had meningitis.
  
  
  CONCLUSIONS
  Children with influenza were more likely to undergo LP on presentation to hospital compared with those presenting with ORVIs. If influenza is confirmed on admission by near-patient testing, clinicians may be reassured and less inclined to perform LP, although if meningitis is clinically suspected, the clinician should act accordingly. We found that the risk of bacterial meningitis and bacteraemia was very low in hospitalised children with influenza and ORVIs. A systematic review should be performed to investigate this across a large number of settings.
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead and The University of SydneyThe Children's Hospital at Westmead and The University of SydneyThe Sydney Institute for Emerging Infections and Biosecurity (SEIB), Sydney Medical School, The University of SydneyDiscipline of Paediatrics and Child Health, Sydney Medical School, The University of SydneyThe Australian Paediatric Surveillance UnitCentre for Infectious Diseases and Microbiology Laboratory Services (CIDMLS), Institute for Clinical Pathology and Medical Research (ICPMR), Westmead Hospital and The University of Sydney, Sydney, NSW, Australia.
authors.forename: Gulam
authors.initials: G
authors.lastname: Khandaker
authors.forename: Leon
authors.initials: L
authors.lastname: Heron
authors.forename: Harunor
authors.initials: H
authors.lastname: Rashid
authors.forename: Jean
authors.initials: J
authors.lastname: Li-Kim-Moy
authors.forename: David
authors.initials: D
authors.lastname: Lester-Smith
authors.forename: Alison
authors.initials: A
authors.lastname: Kesson
authors.forename: Mary
authors.initials: M
authors.lastname: McCaskill
authors.forename: Cheryl
authors.initials: C
authors.lastname: Jones
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Zurynski
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Elliott
authors.forename: Dominic E
authors.initials: DE
authors.lastname: Dwyer
authors.forename: Robert
authors.initials: R
authors.lastname: Booy
mesh_terms: D000293:Adolescent; D001315:Australia; D016470:Bacteremia / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis*; D012141:Respiratory Tract Infections / Q000175:diagnosis*; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000706:statistics & numerical data*; D014777:Virus Diseases / Q000175:diagnosis*; D055815:Young Adult
keywords: Bacterial meningitis; children; influenza; lumbar puncture; respiratory viral infection