Ed. Barnett et al., SERIOUS BACTERIAL-INFECTIONS IN FEBRILE INFANTS AND CHILDREN SELECTEDFOR LUMBAR PUNCTURE, The Pediatric infectious disease journal, 13(11), 1994, pp. 950-953
Lumbar puncture (LP) is performed frequently in pediatric emergency de
partments to diagnose meningitis in infants and young children with fe
ver. Children selected to have LP who do not have meningitis may, howe
ver, have other serious bacterial infections. We surveyed lumbar punct
ures performed in the Boston City Hospital Pediatric Emergency Departm
ent and monitored the incidence of meningitis and other serious bacter
ial infections. Meningitis was diagnosed in 8% of children who underwe
nt LP. An additional 10.5% of children who underwent LP and had normal
cerebrospinal fluid had positive cultures of blood (3.1%), urine (4.1
%) or stool (3.3%). The decision to perform lumbar puncture identifies
children at risk of having not only meningitis but other serious bact
erial illnesses. Those children 2 years of age and younger with normal
cerebrospinal fluid should be considered for cultures of blood, urine
and possibly stool.