Dear Editor
We thank Dr Isaacs for his helpful letter. He rightly points out
that the published recommendations as to which Glasgow Coma Scale score
serves as a contraindication to a lumbar puncture vary between < 8 and
< 13, though we are not aware of any definitive evidence supporting
either value. For the purposes of our overview commentary we chose the
most conservative value (<13), which is also that recommended in the
Advanced Paediatric Life Support Manual produced by the RCPCH advisory
committee. Opinions will vary as to what level of consciousness is a
contraindication to LP. In our clinical practice we do perform LPs on
children with lower coma scores if there are no other contraindications to
LP. These issues clearly deserve further consideration, but for this
Editorial our primary concern related to the observation that even many
fully conscious children do not undergo LP for the spurious reasons
outlined in our article.
In the Editorial we refer to a survey of LP practice in Liverpool,
which were unpublished observations at the time; these data have now also
been published.[1].
References
(1) Kneen, R, Solomon T, Appleton RE. The role of lumbar puncture in
children with suspected central nervous system infection. BMC Pediatrics
2002, 2:8.
This article is available free online from:http://www.biomedcentral.com
Dear Editor
We thank Dr Isaacs for his helpful letter. He rightly points out that the published recommendations as to which Glasgow Coma Scale score serves as a contraindication to a lumbar puncture vary between < 8 and < 13, though we are not aware of any definitive evidence supporting either value. For the purposes of our overview commentary we chose the most conservative value (<13), which is also that recommended in the Advanced Paediatric Life Support Manual produced by the RCPCH advisory committee. Opinions will vary as to what level of consciousness is a contraindication to LP. In our clinical practice we do perform LPs on children with lower coma scores if there are no other contraindications to LP. These issues clearly deserve further consideration, but for this Editorial our primary concern related to the observation that even many fully conscious children do not undergo LP for the spurious reasons outlined in our article.
In the Editorial we refer to a survey of LP practice in Liverpool, which were unpublished observations at the time; these data have now also been published.[1].
References
(1) Kneen, R, Solomon T, Appleton RE. The role of lumbar puncture in children with suspected central nervous system infection. BMC Pediatrics 2002, 2:8.
This article is available free online from:http://www.biomedcentral.com