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Testing for meningitis in children with bronchiolitis
Michael Stefanski1, Ronald Williams2, George McSherry3
1Internist and Pediatrician at Penn State University Hershey Medical Center in PA. mstefanski@hmc.psu.edu.
The Permanente Journal
|February 10, 2015
Summary
Young infants hospitalized with viral bronchiolitis often undergo lumbar puncture for meningitis evaluation. However, only young age, not other clinical factors, significantly influences this decision in bronchiolitis cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Viral bronchiolitis is a common cause of infant hospitalization, often presenting with fever.
- Serious bacterial infections, including meningitis, are rare in infants with viral bronchiolitis.
- Lumbar puncture is frequently performed in infants with bronchiolitis, despite low rates of bacterial meningitis.
Purpose of the Study:
- To identify clinical factors influencing physician decisions to perform lumbar puncture in infants with viral bronchiolitis.
- To analyze the association between clinical variables and lumbar puncture performance.
- To determine the significance of various factors in the diagnostic workup for meningitis in bronchiolitis.
Main Methods:
- Retrospective case-control study design.
- Inclusion of hospitalized infants under one year old diagnosed with viral bronchiolitis.
- Analysis of clinical, demographic, laboratory, and radiologic data.
Main Results:
- Apnea, cyanosis, meningeal signs, positive urine culture, and young age were initially associated with lumbar puncture.
- Multivariable regression analysis revealed young age as the sole significant factor influencing lumbar puncture decisions.
- No other demographic, clinical, laboratory, or radiologic variables demonstrated statistical significance.
Conclusions:
- Physician decisions to perform lumbar puncture in infants with viral bronchiolitis are primarily influenced by patient age.
- Routine lumbar puncture in bronchiolitis may not be consistently guided by other clinical indicators of serious bacterial infection.
- Further research may refine guidelines for lumbar puncture in infants with viral bronchiolitis.
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