Fellow University of Florida College of Medicine Jacksonville, Florida, United States
Background: Diagnosing meningitis is an integral part of the infant sepsis evaluation that requires a lumbar puncture (LP) and obtaining interpretable cerebrospinal fluid (CSF) for biochemical analysis and culture. Contamination with blood may hinder correct interpretation of CSF, and multiple attempts are uncomfortable for the patient, distressing to the family, and may increase contamination. The youngest infants have the highest rates of meningitis and unsuccessful lumbar punctures. Objective: We aim to determine the factors associated with obtaining any CSF and interpretable CSF on first-attempt in infants less than 2 months of age during sepsis evaluation. Design/Methods: We performed a retrospective chart review of infants undergoing sepsis evaluation at a children’s hospital’s emergency department (ED) and ward and multiple regional/community EDs between 2002 and 2022. Charts were identified in the electronic medical record with inclusion criteria of age less than 2 months undergoing sepsis evaluation with a lumbar puncture attempt. Patient factors were collected including age in days, weight, blood urea nitrogen (BUN), and specific gravity (as surrogates for hydration). Additionally, we recorded whether CSF was obtained, number of RBCs, number of attempts, use of sedation/local anesthetic, position (sitting or decubitus), and ultrasound use. Interpretable CSF was defined as < 1000 RBCs/mm3. The two primary outcomes were CSF culture obtained and interpretable CSF obtained on first attempt. Secondary outcomes included CSF culture and interpretable CSF obtained regardless of attempt number. Next, we will perform bivariate comparisons of our nominal variables to determine factors associated with LP success using chi-square or Fisher’s exact tests. Using the Wilcoxon rank sum test or T test, we will compare the ages, weights, BUN, and specific gravities of patients with successful and unsuccessful LPs. Finally, a logistic regression using all the factors for both primary outcomes will be performed.
