Diagnostic Yield of Lumbar Puncture in Children: A 153-Case Retrospective Series

Objective: To evaluate clinical, laboratory, cerebrospinal fluid (CSF), and imaging factors associated with significant CSF abnormality in children undergoing lumbar puncture (LP). Methods: We retrospectively analyzed 153 patients who underwent LP between 2017 and 2022. Significant CSF abnormality was defined using prespecified CSF criteria. Results: Significant CSF abnormality occurred in 41 patients (26.8%); 38 (24.8%) had definite or suspected central nervous system infection, including 13 microbiologically confirmed. Vomiting, headache, and meningeal irritation signs were more frequent, whereas seizures were less frequent, in patients with significant CSF abnormality. Procalcitonin showed limited discrimination (area under the receiver operating characteristic curve [AUC], 0.596; 95% CI, 0.479-0.712; P = .107). Meningeal irritation signs and headache remained independently associated with the outcome. Conclusion: In this LP-selected cohort, clinical findings were more informative than systemic inflammatory biomarkers.