Comparing the Use of, and Considering the Need for, Lumbar Puncture in Children With Influenza or Other Respiratory Virus Infections

Gulam Khandaker; Leon Heron; Harunor Rashid; Jean Li-Kim-Moy; David Lester-Smith; Alison Kesson; Mary McCaskill; Cheryl Jones; Yvonne Zurynski; Elizabeth J. Elliott; Dominic E. Dwyer; Robert Booy


Influenza Resp Viruses. 2013;7(6):932-937. 

In This Article


Demography and Clinical Presentation

In 2007, influenza and ORVIs were laboratory-confirmed in 294 children who are presented to the CHW. Their median age was 14·5 months (range 13 days–19 years); 150 (51%) children had influenza (144 influenza A and six influenza B) and 144 (49%) had ORVIs (89 parainfluenza 3, 44 adenovirus, six parainfluenza 1 and five parainfluenza 2). The demographics and the presenting symptoms of these children are presented in Table 1. Of the influenza cases, 25 (16·6%) were aged <3 months compared with nine of 144 (6·2%) in the ORVI group (P < 0·01). The distribution of respiratory viruses by age group is shown in Figure 1. Mean body temperature on presentation was significantly higher in the influenza group compared with that in the ORVI group (38·6 versus 38·0°C, P < 0·01) as was the mean heart rate (160 versus 152, P < 0·01). There were no significant differences in terms of gender, oxygen saturation and respiratory rate on presentation between the groups.

Figure 1.

Distribution of respiratory viruses by age groups.

Investigations on Presentation and SBI

Of the 150 influenza cases, 27 (18%) had a LP as part of assessment compared with nine of 144 (6·3%) in the other group (P < 0·01); 71% (107/150) of those with influenza had a blood culture performed compared with 56% (80/144) in the ORVI group (P < 0·01; Table 2).

There were no cases of bacterial meningitis in either group. Only one child (0·9%) with laboratory-confirmed influenza had bacteraemia (Enterobacter cloacae), and none in the ORVIs had bacteraemia (P = 0·9). Among those tested, 7 (10·6%) children with influenza had UTI diagnosed and another 7 (14·9%) children with ORVIs had UTI (P = 0·57; Table 3).

Predictors of Invasive Procedures on Presentation

In the multivariate analysis, we explored the likelihood of an invasive procedure based on several predictors including the presenting symptoms, age and respiratory viral diagnosis. A diagnosis of influenza (P = 0·02) and age ≤3 months (P < 0·01) were the only significant independent predictors of a LP, whereas a high temperature (≥39·5°C) or having a febrile convulsion was not predictive.

Independent predictors of having a blood culture performed on presentation were as follows: a diagnosis of influenza (P = 0·05) and temperature of ≥39·5°C (P < 0·01), whereas age ≤3 months did not reach the level of significance (P = 0·06). In comparing influenza with ORVIs, influenza-positive cases were almost three times more likely (OR 2·8, 95% CI 1·4–5·9) to have had a LP performed and 1·3 times (95% CI 1·0–1·5) more likely to have a blood culture on presentation to hospital.

Most influenza cases were presented during July and August, whereas the ORVI cases were predominant in an overlapping period between August and October. Figure 2 shows the seasonal distribution of influenza and ORVIs and the rate of invasive procedures according to the date of presentation. A distinct seasonal pattern of the rate of performance of invasive procedures corresponding to the peak of influenza is apparent.

Figure 2.

Number of influenza and other respiratory viral infections and invasive procedures according to the month of presentation.