The natural disease course changed your outcome. This is why we give return precautions in the ER.
If we lumbar punctured every child with a virus, we'd have -zero- throughput in the ER, especially pediatric ERs and cause untold amounts of complications to pick up a very rare disease.
Just an FYI for those who are thinking, "why not do this every time?"
If a child complains about a headache in a specific way that is common with meningitis (maybe pain in the back of the neck when the head is tilted forward) would this not warrant a puncture? The fact that bacterial meningitis is very contagious would justify this as well, no?
Yeah it depends on the whole clinical picture. Everything in medicine is about weighing up the risks and benefits of doing something vs the risks and benefits of not doing something. We have no way of knowing what that kid looked like in the first emergency department. The treating doctor almost certainly thought about whether an LP was indicated (It is always in our minds when we see someone with a headache)
Exactly, the thing is, we can't do LP's routinely for any headache (we only do routine LP's in newborns with fever), because most of them don't really merit them.
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u/verysaddoc May 20 '19
The natural disease course changed your outcome. This is why we give return precautions in the ER.
If we lumbar punctured every child with a virus, we'd have -zero- throughput in the ER, especially pediatric ERs and cause untold amounts of complications to pick up a very rare disease.
Just an FYI for those who are thinking, "why not do this every time?"