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Lumbar puncture in children with periorbital and orbital cellulitis
1Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland 21205.
Insights
Lumbar puncture (LP) frequency increased in children with periorbital cellulitis without a rise in meningitis diagnoses. Judicious use of LP is recommended for these pediatric patients.
Area of Science:
- Pediatric infectious diseases
- Ophthalmology
- Neurology
Background:
- Periorbital and orbital cellulitis are common pediatric infections.
- Lumbar puncture (LP) is sometimes used to diagnose or rule out meningitis in these cases.
- The diagnostic utility of LP in this population has been questioned.
Purpose of the Study:
- To determine the frequency of lumbar puncture (LP) use in children diagnosed with periorbital or orbital cellulitis between 1979 and 1991.
- To evaluate the diagnostic value of LP in this patient group.
Main Methods:
- Retrospective review of computerized discharge diagnoses and medical records.
- Analysis of 214 children under 18 with periorbital or orbital cellulitis treated at a tertiary care hospital.
- Comparison of LP rates and bacterial meningitis diagnoses over two distinct periods (1979-1984 and 1985-1991).
Main Results:
- Lumbar puncture (LP) was performed in 45% of the 214 children.
- Only 1% of patients were diagnosed with meningitis, and this was suspected prior to LP.
- The rate of LP increased significantly from 14% in 1979-1984 to 62% in 1985-1991.
- Afebrile children over two months old were significantly more likely to undergo LP in the later study period.
Conclusions:
- Increased use of lumbar puncture (LP) in children with periorbital/orbital cellulitis from 1985-1991 did not correlate with an increased diagnosis of early or unsuspected meningitis.
- These findings suggest that lumbar puncture may be overutilized in this patient population.
- A more judicious approach to performing LP in children with periorbital swelling is warranted.
Objective:
To measure the frequency with which lumbar puncture (LP) was performed in children with periorbital and orbital cellulitis in the years 1979 through 1991, and to examine its value as a diagnostic test in these patients.
Design:
Retrospective review of both computerized discharge diagnoses and medical records.
Setting:
Tertiary care hospital.
Patients:
Two hundred fourteen children younger than 18 years of age discharged between Jan. 1, 1979, and Dec. 31, 1991, with a final diagnosis of periorbital or orbital cellulitis.
Main Outcome Measures:
Rates of LP and of bacterial meningitis.
Results:
Of the 214 patients, 96 (45%) had LPs. Two children (1%) had meningitis; in both, the diagnosis was strongly suspected before the LP was performed. No other subject had a discharge diagnosis of meningitis. During the 13 years of study, the proportion of patients in whom LP was performed increased from 14% in the first 6 years (1979 through 1984) to 62% from 1985 through 1991 (p < 0.0001). Those older than 2 months who were afebrile on arrival in the emergency department were 12.4 times more likely to have an LP in 1985 through 1991 than in 1979 through 1984 (p = 0.005).
Conclusions:
The increase in the number of LPs performed from 1985 through 1991 in children with periorbital or orbital cellulitis was not accompanied by an increase in the diagnosis of early or unsuspected meningitis. These data suggest the need for more judicious use of LP in children with periorbital swelling.