This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Holzman, I. R.
Right arrow Articles by Mazor, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Holzman, I. R.
Right arrow Articles by Mazor, S.
PEDIATRICS Vol. 113 No. 1 January 2004, pp. 172

Traumatic Lumbar Punctures

Ian R. Holzman, MD
Mount Sinai School of Medicine New York, NY 10029, USA

The first 20% of the full text of this article appears below.

To the Editor.—

Mazor et al1 have attempted to clarify an age-old dilemma concerning traumatic lumbar punctures. The use of the white blood cells (WBC)/red blood cells ratio and the observed/predicted ratio seem to be helpful in determining who doesn’t have a positive cerebrospinal fluid (CSF) culture. Unfortunately, the authors fail to point out an underlying confound in the literature and in their data. Patients with a positive culture from blood CSF may not necessarily have meningitis but rather may have bacteremia. I see no easy way to determine in those cases where the WBC count is not clearly markedly different from the peripheral WBC count (and the glucose and protein aren’t equally different) that the positive CSF culture doesn’t reflect bacteria introduced from the peripheral blood. It would be reassuring to know whether the peripheral blood culture was negative (assuming an adequate sample was drawn) before determining whether a positive CSF culture represented meningitis, but even this is not foolproof. The final word is not in yet!

  1. Mazor SS, McNulty JE, Roosevelt GE. Interpretation of traumatic lumbar punctures: Who can go home? Pediatrics.2003; 111 :525 –528[Abstract/Free Full Text]
 
James A. Berkley, MD
Isiaih Mwangi, MB, ChB
Brett Lowe, MPhil
Charles R. J. C. Newton, . . . [Full Text of this Article]