Suspected Meningitis Age > 56 days Clinical Pathway — Emergency Department, Inpatient and ICU
CSF studies
Viral testing is very unlikely to be positive when CSF WBC < 5 and CSF RBC < 500 for healthy children age > 6 months.
Recommended CSF Studies1
| Recommended CSF Studies | Tube Number | Minimum Volume |
|---|---|---|
| Opening pressure (if age > 1 year) |
Manometer | CSF entering the manometer can be emptied into Tube 1 and used for cell count and differential |
| Cell count and differential | Tube 1 | 1 mL |
| CSF Gram stain and culture | Tube 2 | 0.2 - 0.5 mL (aim for at least 1.5 mL to include Save Our Specimen) |
| Protein, glucose | Tube 3 | 0.3 mL |
| Cell count and differential | Tube 4 | 1 mL |
Additional Studies
| Additional Studies | Tube Number | Minimum Volume |
|---|---|---|
| Additional viral studies if required 2, Save Our Specimen 3 | Tube 2 | 0.25 mL for each viral PCR 1 mL additional for Save Our Specimen4 |
1. If there is limited CSF available, prioritize the CSF Gram stain and culture first as well as HSV PCR (if applicable). Cell count with differential should be prioritized next.
2. If a viral PCR such as HSV PCR is indicated at the time of CSF collection, please submit separate orders for these tests at the time of collection. In general, waiting for the cell counts to come back to determine whether the patient has a CSF pleocytosis is recommended prior to ordering viral PCRs or other infectious diseases diagnostics. These tests can be added by entering orders in Epic and adding “Specimen in lab” to the order.
3. The “Save Our Specimen” order should be linked to Tube 2, as this tube is kept under sterile conditions in Microbiology and can be used for further testing such as PCR testing when needed.
4. CSF designated as “Save Our Specimen” should be used for tests not anticipated at the time of CSF collection. Each viral PCR requires 0.25 mL. For other testing, variable amounts required. Refer to online laboratory directory for further information.
Standard Precautions for LP
| Sterile field with sheets and drapes | |
|---|---|
| Gloves | |
| Gown | |
| Mask | Consider in cases where there is a high suspicion of meningitis |