Published online May 18, 2009
PEDIATRICS Vol. 123 No. 6 June 2009, pp. e967-e971 (doi:10.1542/peds.2008-1742)

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ARTICLE

Diagnostic Value of Immature Neutrophils (Bands) in the Cerebrospinal Fluid of Children With Cerebrospinal Fluid Pleocytosis

John T. Kanegaye, MD^a, Lise E. Nigrovic, MD, MPH^b, Richard Malley, MD^b, Christopher R. Cannavino, MD^c,d, Sandra H. Schwab, MD^e, Jonathan E. Bennett, MD^f, Michael M. Mohseni, MD^g, Vincent J. Wang, MD^h, Yiannis L. Katsogridakis, MD, MPHⁱ, Martin I. Herman, MD^j, Nathan Kuppermann, MD, MPH^k,l for the American Academy of Pediatrics, Pediatric Emergency Medicine Collaborative Research Committee

^a Divisions of Emergency Medicine
^c Infectious Diseases
^d Hospital Medicine, Rady Children's Hospital San Diego and School of Medicine, University of California, San Diego, La Jolla, California
^b Department of Medicine, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
^e Department of Pediatrics, Children's Hospital of Philadelphia and School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
^f Department of Pediatrics, Alfred I. duPont Hospital for Children and Jefferson Medical College, Wilmington, Delaware
^g Department of Emergency Medicine, Children's Medical Center and Medical College of Georgia, Augusta, Georgia
^h Division of Emergency Medicine, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
ⁱ Department of Pediatrics, Children's Memorial Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
^j Department of Pediatrics, Le Bonheur Children's Medical Center and College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
^k Departments of Emergency Medicine
^l Pediatrics, University of California, Davis, Medical Center Sacramento, California and School of Medicine, University of California, Davis, California

OBJECTIVE. We evaluated the diagnostic utility of the presence and number of cerebrospinal fluid (CSF) bands in distinguishing bacterial from aseptic meningitis among children with CSF pleocytosis.

METHODS. We identified retrospectively a cohort of children 29 days to 19 years of age with CSF pleocytosis (10 x 10⁶ leukocytes per L) who were treated in the emergency departments of 8 pediatric centers between January 2001 and June 2004 and whose CSF was evaluated for the presence of bands. We performed bivariate and multivariate analyses to determine the ability of CSF bands to distinguish bacterial from aseptic meningitis.

RESULTS. Among 1116 children whose CSF was evaluated for the presence of bands, 48 children (4% of study patients) had bacterial meningitis. Bacterial meningitis, compared with aseptic meningitis, was associated with a greater CSF band proportion (0.03 vs 0.01; difference: 0.02; 95% confidence interval: 0.00–0.04) and CSF absolute band count (392 x 10⁶ cells per L vs 3 x 10⁶ cells per L; difference: 389 x 10⁶ cells per L; 95% confidence interval: –77 x 10⁶ cells per L to 855 x 10⁶ cells per L). In addition, 29% of patients with bacterial meningitis, compared with 18% of patients with aseptic meningitis, had any bands detected in the CSF. After adjustment for other factors associated with bacterial meningitis, however, CSF band presence, CSF absolute band count, and CSF band proportion were not independently associated with bacterial meningitis.

CONCLUSION. In this multicenter study, neither the presence nor quantity of CSF bands independently predicted bacterial meningitis among children with CSF pleocytosis.

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Key Words: cerebrospinal fluid • immature neutrophils • bands • bacterial meningitis • aseptic meningitis

Abbreviations: CSF—cerebrospinal fluid • ED—emergency department • WBC—white blood cell • ROC—receiver operating characteristic • ABC—absolute band count • ANC—absolute neutrophil count • CI—confidence interval • AUC—area under the curve

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Accepted Feb 12, 2009.

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