title: The effect of traumatic lumbar puncture on hospitalization rate for febrile infants 28 to 60 days of age.
abstract: OBJECTIVE
  The authors measured the effect of a traumatic or unsuccessful lumbar puncture (LP) on the management of febrile infants.
  
  
  METHODS
  This was a 10-year retrospective cross-sectional study of low-risk infants by the "Boston" criteria 28 to 60 days of age presenting to the emergency department for evaluation of fever. "Normal LP" infants had cerebrospinal fluid (CSF) WBC < 10 × 10(6) cells/L. "Traumatic" or "unsuccessful LP" infants had CSF red blood cell count ≥ 10 × 10(9) cells/L or no CSF cell counts obtained, respectively. A serious bacterial infection (SBI) was defined as growth of a bacterial pathogen from culture. The hospitalization and SBI rates were compared between infants with normal versus traumatic or unsuccessful LPs.
  
  
  RESULTS
  Of the 929 study infants, 756 (81.4%) had normal LPs, and 173 (18.6%) had traumatic or unsuccessful LPs. Infants with traumatic or unsuccessful LPs had a higher hospitalization rate (72.3% traumatic or unsuccessful LP vs. 18.1% normal LP; difference = 54.1%; 95% confidence interval [CI] = 46.4% to 60.8%), but a similar SBI rate (2.9% vs. 4.1%; difference = 1.2%; 95% CI = -2.7% to 3.6%). No infant had proven bacterial meningitis (0% risk, 95% CI = 0 to 0.3%).
  
  
  CONCLUSIONS
  Low-risk infants aged 28 to 60 days with traumatic or unsuccessful LPs are more frequently hospitalized, although SBI rates were similar to those of infants with normal LPs.
authors: Department of Medicine, Boston Children's Hospital, Boston, MA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA.
authors: Elizabeth W
authors: EW
authors: Pingree
authors: Amir A
authors: AA
authors: Kimia
authors: Lise E
authors: LE
authors: Nigrovic
mesh_terms: D001424:Bacterial Infections / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D001772:Blood Cell Count; D001900:Boston; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D012307:Risk Factors; D013129:Spinal Puncture / Q000706:statistics & numerical data*