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New insights into the glucose oxidase stick test for cerebrospinal fluid rhinorrhoea
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  1. E H Baker,
  2. D M Wood,
  3. A L Brennan,
  4. D L Baines,
  5. B J Philips
  1. Glucose and Pulmonary Infection Group, St George’s, University of London, London, UK
  1. Correspondence to:
 Dr Emma Baker
 Reader in Clinical Pharmacology, Cardiac and Vascular Sciences, Physiological Medicine, St George’s, University of London, Cranmer Terrace, London, SW17 0RE, UK; ebakersgul.ac.uk

Abstract

Rhinorrhoea is a clinical sign of cerebrospinal fluid (CSF) leakage in patients with skull fracture, but can also be attributable to respiratory secretions or tears. Laboratory tests confirming the presence of CSF are not sufficiently rapid to support clinical decision making in the emergency department and may not be universally available.

Detection of glucose in nasal discharge was traditionally used to diagnose CSF leak at the bedside, but has fallen into disuse as it has poor positive predictive value. We propose an algorithm to improve the diagnostic value of this test taking into consideration factors we have found to affect the glucose concentration of respiratory secretions. In patients at risk of CSF leak, nasal discharge is likely to contain CSF if glucose is present in the absence of visible blood, if blood glucose is <6 mmol.L−1, and if there are no symptoms of upper respiratory tract infection.

  • CSF, cerebrospinal fluid
  • glucose
  • cerebrospinal fluid
  • rhinorrhoea
  • hyperglycaemia
  • inflammation

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Footnotes

  • Funding: none.

  • Competing interests: none declared

  • Statement: The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd and its Licensees to permit this article (if accepted) to be published in EMJ editions and any other BMJPG Ltd products to exploit all subsidiary rights, as set out in our licence.

  • Ethical approval: approval obtained.

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