The DOI matches its Crossref record; 9 of the 9 references it cites were found in a registry or an index.
Clinical Utility of CSF Correction Factors for Traumatic Lumbar Puncture in Adults
Open accessAbstract
Objectives: To identify indicators of false pleocytosis in adults with traumatic lumbar puncture (LP), and determine specificities and sensitivities of commonly used CSF correction factors. Methods: Adults who underwent 4-tube CSF collection were reviewed. Study inclusion required elevated tube 1 red blood cell (RBC) count, tube 1 pleocytosis, and normalized tube 4 RBC count. Tube 4 white blood cell (WBC) count served as the reference standard. Specificities and sensitivities of 3 correction factors (1 WBC:500 RBC, 1 WBC:1000 RBC, and 1 WBC:1500 RBC) were calculated. Results: One hundred ninety-five adults were included. Among them, 106 (54%) had false tube 1 pleocytosis; these patients had a significantly higher median CSF RBC count and lower median CSF WBC count than those with true tube 1 pleocytosis. Specificities and sensitivities of correction factors ranged from 71.7% to 29.2% and 84.3% to 97.8%, respectively; 1 WBC:500 RBC had highest specificity for pleocytosis, while 1 WBC:1500 RBC had highest sensitivity. Irrespective of correction factor used, false-positive and false-negative determinations of pleocytosis were usually mild (≤20 WBCs/μL). Discussion: Indicators of false pleocytosis in adults with traumatic LP include bloodier CSF and milder pleocytosis, suggesting that correction factors are most useful in such cases. Across correction factors, an expected specificity/sensitivity tradeoff is observed. Corrected CSF WBC counts suggesting only mild pleocytosis should be interpreted cautiously.
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“Traumatic lumbar puncture can spuriously raise CSF WBC, so the white cell-to-red cell ratio may help interpret cytology and guide the use of FAME testing (29); nevertheless, we observed FAME positives even with very high RBC counts.”
From Optimized use of the FilmArray Meningitis/Encephalitis panel for early discontinuation of antibiotic therapy (2026) · cites this paper as [29]
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A clinical approach to diagnosis of autoimmune encephalitis
Graus, F., Titulaer, M. J., Balu, R., Benseler, S. M., Bien, C. G., Cellucci, T., Cortese, I. C. M., Dale, R. C., Gelfand, J. M., Geschwind, M. D., et al. (2016) · The Lancet Neurology · doi:10.1016/s1474-4422(15)00401-9 · Cited by 4,580
Autoimmune Encephalitis Misdiagnosis in Adults
Flanagan, E. P., Geschwind, M. D., Lopez-Chiriboga, A. S., Blackburn, K. M., Turaga, S., Binks, S. N. M., Zitser, J., Gelfand, J. M., Day, G. S., Dunham, S. R., et al. (2022) · JAMA Neurology · doi:10.1001/jamaneurol.2022.4251 · Cited by 311
Cerebrospinal Fluid Findings in Patients With Autoimmune Encephalitis—A Systematic Analysis
Blinder, T., & Lewerenz, J. (2019) · Frontiers in Neurology · doi:10.3389/fneur.2019.00804 · Cited by 197
Traumatic Lumbar Punctures in Neonates
Greenberg, R. G., Smith, P. B., Cotten, C. M., Moody, M. A., Clark, R. H., & Benjamin, D. K. (2008) · The Pediatric Infectious Disease Journal · doi:10.1097/inf.0b013e31817e519b · Cited by 118
Incidence of Traumatic Lumbar Puncture
Shah, K. H., Richard, K. M., Nicholas, S., et al. (2003) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2003.tb00033.x · Cited by 104
Perry, J. J., Alyahya, B., Sivilotti, M. L. A., et al. (2015) · BMJ · doi:10.1136/bmj.h568 · Cited by 79
Shahan, B., Choi, E. Y., & Nieves, G. (2021) · PubMed · Cited by 67
Lyons, T. W., Cruz, A. T., Freedman, S. B., Neuman, M. I., Balamuth, F., Mistry, R. D., Mahajan, P., Aronson, P. L., Thomson, J. E., Pruitt, C. M., et al. (2016) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2016.10.008 · Cited by 56
Kleine, T. O., Nebe, C. T., Löwer, C., et al. (2010) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm.2010.168 · Cited by 10
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Nicolau-Guillaumet, N., Moutel, M., Plouzeau-Jayle, C., Pean de Ponfilly, G., Courbin, V., Ranc, A.-G., Revillet, H., Mourvillier, B., Hentzien, M., Muggeo, A., et al. (2026) · Microbiology Spectrum · doi:10.1128/spectrum.00566-26 · Cited by 1
“Traumatic lumbar puncture can spuriously raise CSF WBC, so the white cell-to-red cell ratio may help interpret cytology and guide the use of FAME testing (29); neverthe less, we observed FAME positives even with very high RBC counts.”
Metadata
- Authors
- Zhou, R. W., Sangam, K., & Budhram, A.
- Affiliations
- Western University (CA)
- Corresponding author
- Budhram, Adrian
- Venue
- Neurology Clinical Practice
- Published
- 2024-12
- Volume
- 14
- Issue
- 6
- Pages
- e200350-e200350
- ISSN
- 2163-0402 (ISSN-L)
- 2163-0933
- PMC
- PMC11341082
- OpenAlex
- W4401633003
- Cited by
- 3
- References
- 9
- Citations by year
- 2026: 3
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Neurology Clinical Practice (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Clinical Neurology › Neurosurgical Procedures and Complications
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pleural and Pulmonary Diseases
- Keywords
- traumatic lumbar puncture, CSF white blood cell count, sensitivity and specificity
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