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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…