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Clinical usefulness of cerebrospinal fluid bacterial antigen studies
S Maxson1, M J Lewno, G E Schutze
1Division of Infectious Diseases, Arkansas Children's Hospital, Little Rock 72202.
Abstract:
A retrospective chart review was performed to evaluate the effect that positive results of cerebrospinal fluid bacterial antigen tests had on the care of patients with presumed bacterial meningitis. Of 901 tests ordered, costing $26,000 per year, 29 showed positive results--and only four of these affected patient care. By using cerebrospinal fluid bacterial antigen testing only when another test does not identify an organism, or in an attempt to determine central nervous system infection late in therapy for presumed sepsis, one can greatly reduce costs with no detrimental effect on patients.
Insights
Cerebrospinal fluid bacterial antigen tests for meningitis are costly and rarely change patient care. Limiting testing to specific situations can reduce expenses without harming patients.
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Clinical Microbiology
Background:
- Bacterial meningitis requires prompt diagnosis and treatment.
- Cerebrospinal fluid (CSF) analysis is crucial for diagnosing meningitis.
- Bacterial antigen tests in CSF can aid diagnosis but their clinical utility and cost-effectiveness are debated.
Purpose of the Study:
- To evaluate the impact of positive CSF bacterial antigen test results on patient management.
- To assess the cost-effectiveness of CSF bacterial antigen testing in presumed bacterial meningitis.
Main Methods:
- Retrospective chart review of patients with presumed bacterial meningitis.
- Analysis of CSF bacterial antigen test orders, results, and impact on clinical decisions.
- Calculation of annual testing costs.
Main Results:
- 901 CSF bacterial antigen tests were performed, costing $26,000 annually.
- Only 29 tests yielded positive results.
- Positive results altered patient care in only four instances.
Conclusions:
- CSF bacterial antigen testing is infrequently positive and rarely influences patient care.
- Selective use of CSF bacterial antigen testing, such as when other methods fail or for late sepsis evaluation, can significantly reduce costs.
- Current testing protocols may not be cost-effective, suggesting a need for revised guidelines.