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[Lumbar puncture in a pediatric emergency department: something more than a diagnostic technic]
S Mintegui Raso1, J Benito Fernández, J Sánchez Echániz
1Urgencias de Pediatría, Departamento de Pediatría, Hospital de Cruces, Cruces-Barakaldo, Bizkaia.
Insights
Serious bacterial infections (SBI) occur in 14.1% of children without sepsis or intracranial infection who undergo lumbar puncture (LP). Younger children (<5 years) have a higher incidence of SBI, emphasizing the need for careful examination and targeted cultures in febrile pediatric patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Emergency Medicine
Context:
- Lumbar puncture (LP) is a common procedure in pediatric emergency departments for febrile children.
- Distinguishing serious bacterial infections (SBI) from other causes of fever is critical for appropriate management.
- Previous studies have focused on the overall incidence of infection, but less is known about SBI in children without sepsis or intracranial findings.
Purpose:
- To determine the incidence of SBI in previously healthy children aged 1 month to 14 years who underwent LP in an emergency department, excluding those with sepsis or intracranial infections.
- To identify risk factors, such as age, associated with SBI in this specific pediatric population.
Summary:
- A retrospective study analyzed 471 children who underwent LP. Of the 254 children without sepsis or intracranial infection, 36 (14.1%) had an SBI, including urinary tract infections, bacteremia, and bacterial gastroenteritis.
- The incidence of SBI was significantly higher in children younger than 5 years (18.2%) compared to older children (5.0%).
- Two deaths occurred, one from pneumococcal meningitis and one from meningococcal sepsis.
Impact:
- Findings highlight the importance of considering SBI even in children without overt signs of severe illness or central nervous system involvement.
- The study suggests that younger children with fever and normal LP results require careful evaluation, including urine, blood, and stool cultures.
- Recommendations include close observation and prompt re-evaluation by a pediatrician within 24 hours for these high-risk pediatric patients.
Objective:
The aim of this study was to know the incidence of serious bacterial infections (SBI) in children without sepsis or intracranial infection in which spinal puncture (LP) was performed in an Emergency Department.
Patients And Methods:
A retrospective study of all 471 previously healthy children between 1 month and 14 years of age in which a lumbar puncture was performed between July 1995 and March 1997 in the Emergency Department of our hospital was performed.
Results:
Two hundred and three children (43%) had sepsis, meningitis or encephalitis (aseptic meningitis 149, 31.6%; sepsis-bacterial meningitis 26, 5.5%; nonspecific meningitis 26, 5.5%; encephalitis 2, 0.4%) and 14 (5.2%) had pneumonia. Of the other 254 children, 36 (14.1%) had a SBI: 19 urinary tract infections (E. coli), 11 bacteremia (Streptococcus pneumoniae 8, Salmonella enteritidis 1, Proteus mirabilis 1, E. coli 1, the latter two also having a positive urine culture) and 6 bacterial gastroenteritis (salmonella 5, Campylobacter jejuni 1). The incidence of SBI was significantly higher in the group of children younger than 5 years old (32/175, 18.2%) than in the older group (4/79, 5.0%, p = 0.009). Two patients died (one with pneumococcal meningitis and one with meningococcal sepsis).
Conclusions:
Children with fever and a normal result in the LP must be carefully examined and, especially in younger patients, urine, blood and stool (if stool abnormalities) cultures should be collected. These children must be closely observed in the hospital or at home and must be re-evaluated by their pediatrician in the following 24 hours.