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Lumbar puncture ordering and results in the pediatric population: a promising data source for surveillance systems
Amir Kimia1, John S Brownstein, Karen L Olson
1Division of Emergency Medicine, Children's Hospital Boston, Boston, MA 02115, USA. amir.kimia@childrens.harvard.edu
Insights
Laboratory test ordering patterns, like lumbar punctures, show seasonal trends and long-term declines. Analyzing these patterns can help detect outbreaks early, but requires adjustments for age and time trends.
Area of Science:
- Public Health Surveillance
- Clinical Laboratory Science
- Epidemiology
Background:
- Real-time surveillance systems are being developed by the CDC using laboratory data.
- Atypical patterns in laboratory test orders may indicate disease outbreaks before results are available.
Purpose of the Study:
- To characterize baseline patterns in lumbar puncture test ordering and early results.
- To explore the potential for using these patterns in real-time surveillance for meningitis or encephalitis outbreaks.
Main Methods:
- Retrospective analysis of pediatric emergency department patients.
- Utilized data from a single hospital (1993-2003) and the National Hospital and Ambulatory Medical Care Survey (1992-2000).
Main Results:
- Lumbar puncture test orders and cerebrospinal fluid pleocytosis rates show seasonal patterns (peaks in January/August and August-October, respectively).
- A significant long-term decline in daily test ordering was observed in both hospital and national samples.
- The rate of pleocytosis has declined, but the yield of testing for it has improved.
Conclusions:
- Laboratory test ordering patterns correlate with clinical disease patterns, showing promise for surveillance.
- Real-time monitoring requires adjustments for patient age, seasonality, and secular trends.
Background:
The Centers for Disease Control and Prevention is incorporating laboratory data into real-time surveillance systems. When normal patterns of laboratory test orders and results are modeled, aberrations can be detected. Because many test orders are available electronically well before results, atypical patterns of test ordering may signal outbreaks.
Objectives:
The authors sought to characterize baseline patterns in the ordering and early results of lumbar punctures, motivated by the possibility of using these data for real-time surveillance for early detection of meningitis or encephalitis outbreaks.
Methods:
Retrospective cohorts of pediatric emergency department patients at a single hospital (1993-2003) and from the National Hospital and Ambulatory Medical Care Survey (1992-2000) were used for analysis.
Results:
Test ordering exhibits seasonal patterns, with monthly peaks in January and August (p < 0.0001). For the hospital cohort, the rate of cerebrospinal fluid pleocytosis exhibits seasonal patterns (p < 0.0001), with a peak from August to October. This is strongly associated with the rate and pattern of clinical neurologic disease (p < 0.0001). A long-term secular decline in daily test ordering is evident, dropping from 5.3 to 2.9 in the hospital sample, and from 371.8 to 185.3 in the national sample (p < 0.001). The long-term rate of pleocytosis has declined (p < 0.0001), though the yield of testing for pleocytosis has improved (p = 0.0104).
Conclusions:
Laboratory test patterns correspond with those of clinical disease and are a promising source of surveillance data. Using such data for real-time monitoring requires specific adjustments for patient age, periodicities, and secular trends.
