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Open Access Highly Accessed Research article

The role of lumbar puncture in children with suspected central nervous system infection

Rachel Kneen1, Tom Solomon2* and Richard Appleton1

Author Affiliations

1 The Roald Dahl EEG Unit, Royal Liverpool Children's NHS Trust, Alder Hey, Liverpool, L12 2AP, UK

2 Department of Neurological Science, University of Liverpool, Walton Centre for Neurology and Neurosurgery, Liverpool, UK and Department of Medical Microbiology and School of Tropical Medicine, University of Liverpool, Liverpool, UK

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BMC Pediatrics 2002, 2:8  doi:10.1186/1471-2431-2-8

Published: 2 September 2002

Abstract

Background

The use of the lumbar puncture in the diagnosis of central nervous system infection in acutely ill children is controversial. Recommendations have been published but it is unclear whether they are being followed.

Methods

The medical case notes of 415 acute medical admissions in a children's hospital were examined to identify children with suspected central nervous system infection and suspected meningococcal septicaemia. We determined whether lumbar punctures were indicated or contraindicated, whether they had been performed, and whether the results contributed to the patients' management.

Results

Fifty-two children with suspected central nervous system infections, and 43 with suspected meningococcal septicaemia were identified. No lumbar punctures were performed in patients with contraindications, but only 25 (53%) of 47 children with suspected central nervous system infection and no contraindications received a lumbar puncture. Lumbar puncture findings contributed to the management in 18 (72%) of these patients, by identifying a causative organism or excluding bacterial meningitis.

Conclusion

The recommendations for undertaking lumbar punctures in children with suspected central nervous system infection are not being followed because many children that should receive lumbar punctures are not getting them. When they are performed, lumbar puncture findings make a useful contribution to the patients' management.