Critical Care, Improving Outcomes, Mythbusting, Pediatrics, Pediatrics

Discharge the LP with 4 WBCs? Not so fast…

At what point do you consider discharging a patient after an LP? Less than 5 WBCs in CSF?  Less than 10?  Less than 20?  What if, after you have empirically given them dexamethasone, ceftriaxone, and compazine, they feel well and have only 8 WBCs?  Perhaps you’re using the bacterial meningitis score?

Well, a single-center study recently looked at outcomes for CSF culture positive bacterial meningitis for pediatric patients, aged 1 month to 18 years.  35% of these patients were under 3 months young, another 26% were 4-11 months, while only 7% were 7-10 years young, and another 4.6% 11-18 years young, so the data was quite skewed towards a younger population, which probably reflects our higher frequency of doing LPs in these age groups.  They excluded traumatic taps.

Bad outcomes were defined as physical or psychological morbidities lasting longer than 6 months after the meningitis episode, including mental retardation, cerebral palsy, ataxia, hearing impairment, and epilepsy.  Lost to follow up was defined as an inability to reach the patient at 6 months after the meningitis episode.  Sequelae were defined as physical or psychological morbidities lasting longer than 6 months after the meningitis episode, including mental retardation, cerebral palsy, ataxia, hearing impairment, and epilepsy.  Lost to follow up was defined as an inability to reach the patient at 6 months after the meningitis episode.

The results?Screen Shot 2015-01-05 at 10.06.00 PM

The numbers are small, but the message concerning:  patients with >5000 WBCs had essentially the same prognosis as those with <5 WBCs.  There have been case reports of this in adults, generally with poor outcomes.  Going forward, if patients have any WBCs, consider placing patients in observation for monitoring and consideration of repeat LP.

Standard

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s