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Correction Factor for CSF Protein Levels in Traumatic Lumbar PunctureSubtract 1.1 mg/dL protein for every 1000-cell increase in CSF red blood cell count.

Traumatic lumbar puncture (LP) is common in children and occurs when the needle causes bleeding into the subarachnoid space. Introduction of peripheral red blood cells (RBCs) in cerebrospinal fluid (CSF) increases CSF protein levels, thereby complicating diagnosis of bacterial meningitis. Investigators examined the association between CSF RBC count and CSF protein level in a prospective cohort of 1298 patients (median age, 3 months; age range, 0 days –23 years) who underwent LP in the emergency department at a children's hospital in Boston and did not have evidence of meningitis. Most LPs were performed to evaluate for possible meningitis.

Overall, 189 patients (15%) had traumatic LPs (CSF RBC count >1000/mm3). CSF protein level increased by 1.1 mg/dL for every 1000-cell increase in CSF RBC count. A similar linear relation between CSF RBC count and protein levels was observed in subgroups of patients without pleocytosis, patients with traumatic LP, and patients who were younger than 90 days. Children with traumatic LP were significantly more likely to be admitted than those with nontraumatic LP.

Comment: As many as 30% of LPs in children are traumatic and lead to uncertain interpretation of CSF protein concentrations. This study identified a correction factor for interpreting CSF protein levels after traumatic LP. If the results are validated, use of this correction factor might prevent unnecessary hospitalizations. The relation between CSF red blood cell count and white blood cell count was not studied.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine August 3, 2011

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