J Korean Soc Emerg Med.  2017 Dec;28(6):643-649. 10.0000/jksem.2017.28.6.643.

Discussion of Lumbar Puncture in Infants Aged Less than 3 Months Who Visited Emergency Department

• Lee SY
• Lee HJ
• Kim JW
• Moon HJ
• Lee DW
• Lee JW
• Choi JH
• Park JS

• KMID: 2403284
• DOI: http://doi.org/10.0000/jksem.2017.28.6.643

Abstract

PURPOSE
This study was conducted to confirm the necessity of lumbar puncture to identify the cause of fever in febrile infants aged less than 3 months who visited an emergency department.
METHODS
This was a retrospective study conducted on 399 infants aged 31 days to 90 days who visited the emergency department with fever from March 2014 to February 2016.
RESULTS
Of the 399 patients, 49 patients had serious bacterial infections (SBI), and were finally diagnosed with urinary tract infection (UTI), sepsis, and bacterial meningitis. Of these, only one case was diagnosed with bacterial meningitis, and this patient was accompanied by sepsis. UTIs were present in 47 patients, and only 1 case was diagnosed with sepsis without bacterial meningitis or UTI. The Boston criteria and Philadelphia criteria included the cerebrospinal fluid (CSF) results for predicting SBI. In this study, the modified Philadelphia criteria was used, which does not include the CSF results, and there was no factor that showed a significant correlation as a result of statistical analysis. Rather, a C-reactive protein ≥50 mg/L, procalcitonin ≥2 ng/mL, and fever over 39℃C showed statistical significance with SBI. In this study, the 1 patient diagnosed with bacterial meningitis also met all three factors (C-reactive protein, 106 mg/L; procalcitonin, 40.25 ng/mL; peak body temperature, >39℃).
CONCLUSION
Because the incidence of bacterial meningitis has decreased recently, when an infant under 3 months of age visits the emergency room with fever, lumbar puncture should be performed selectively to identify the cause.

Keyword

Meningitis; Bacterial; Fever; Spinal puncture; Infant

MeSH Terms

Bacterial Infections
Body Temperature
C-Reactive Protein
Cerebrospinal Fluid
Emergencies*
Emergency Service, Hospital*
Fever
Humans
Incidence
Infant*
Meningitis
Meningitis, Bacterial
Retrospective Studies
Sepsis
Spinal Puncture*
Urinary Tract Infections
C-Reactive Protein