How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis?
Straus SE, Thorpe KE, Holroyd-Leduc J. JAMA. 2006Oct.25;296(16):2012–22.
This systematic literature review and meta-analysis in the Rational Clinical Examination series found a non-significant trend towards less post-LP headache with the use of atraumatic needle and mobilization post-LP. Reinsertion of the stylet significantly reduced post-LP headache and CSF wbc>500 and lactate>3.5mmol/L accurately diagnosed bacterial meningitis. JC attendees felt atraumatic needles should be universally adopted and that CSF lactate should be explored as a test to become available in our ED.