title: Testing for meningitis in children with bronchiolitis.
abstract: Viral bronchiolitis accounts for almost 20% of all-cause hospitalizations of infants (ie, children younger than age 1 year). The annual incidence of fever in viral bronchiolitis has been documented at 23% to 31%. However the incidence of concurrent serious bacterial infections is low (1%-7%), with meningitis occurring in less than 1% to 2% of cases, but lumbar puncture is performed in up to 9% of viral bronchiolitis cases. To our knowledge, no study has examined clinical factors that influence a physician’s decision to perform a lumbar puncture in the setting of viral bronchiolitis. We present a retrospective, case-control study of hospitalized infants younger than one year diagnosed with viral bronchiolitis who underwent lumbar puncture as part of an evaluation for meningitis. The objective of the study was to determine clinical factors that influence a physician’s decision to perform a lumbar puncture in the setting of viral bronchiolitis. Although the presence of apnea, cyanosis, meningeal signs, positive urine culture results, and young age were factors found to be preliminarily associated with the performance of a lumbar puncture in the setting of bronchiolitis, young age was the only significant clinical factor found after multivariable regression; no other demographic, clinical, laboratory, or radiologic variables were found to be significant.
authors: Internist and Pediatrician at Penn State University Hershey Medical Center in PA. mstefanski@hmc.psu.edu.
authors: Michael
authors: M
authors: Stefanski
authors: Professor of Pediatrics and Internal Medicine at Penn State Hershey Children's Hospital in PA. rwilliams@hmc.psu.edu.
authors: Ronald
authors: R
authors: Williams
authors: Pediatrician in the Division of Infectious Diseases at Penn State Hershey Children's Hospital in PA. gmcsherry@hmc.psu.edu.
authors: George
authors: G
authors: McSherry
authors: Vice President of Medical Affairs at Doctors Hospital in Columbus, OH. joseph.geskey@ohiohealth.com.
authors: Joseph
authors: J
authors: Geskey
mesh_terms: D001990:Bronchiolitis, Viral / Q000150:complications*; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D008581:Meningitis / Q000175:diagnosis*; D010414:Pennsylvania; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000706:statistics & numerical data*