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Canadian and UK/Ireland practice patterns in lumbar puncture performance in febrile neonates with bronchiolitis
  1. Laura Simone1,2,
  2. Mark D Lyttle3,
  3. Damian Roland4,5,
  4. Derek Stephens6,7,
  5. Suzanne Schuh1,6,8
  6. for the Pediatric Emergency Research Canada (PERC) and the Pediatric Emergency Research United Kingdom and Ireland (PERUKI) networks
  1. 1 Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2 Department of Pediatrics, University of Toronto, Toronto, ON, Canada
  3. 3 Emergency Department, Bristol Royal Children’s Hospital, Bristol, UK
  4. 4 Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University of Leicester, Leicester, UK
  5. 5 Health Sciences, SAPPHIRE Group, Leicester, UK
  6. 6 Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
  7. 7 University of Toronto, Toronto, ON, Canada
  8. 8 Department of Pediatrics, University of Toronto, Toronto, ON, Canada
  1. Correspondence to Dr Suzanne Schuh, Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada, M5G1X8; suzanne.schuh{at}


Background Serious bacterial infections in young infants with bronchiolitis are rare. Febrile infants <1 month old with bronchiolitis often receive a lumbar puncture (LP), despite limited data for this practice and lack of clinical practice guidelines for this population. The primary objective was to investigate practice patterns in performance of LPs in the ED management of febrile infants aged ≤30 days with bronchiolitis.

Methods A cross-sectional survey of two national paediatric emergency research networks (PediatricEmergency Research Canada (PERC) and the PediatricEmergency Research UK/Ireland (PERUKI)) was conducted January to November 2017 using a modified Dillman technique. The survey was preceded by a clinical vignette describing a well appearing, 21-day-old infant with low-grade fever, respiratory findings typical of bronchiolitis and no perinatal serious bacterial infection (SBI) risk features.

Results The response rate from PERC was 169/250 (68%) and 172/201 (86%) from PERUKI. Nine physicians in training were excluded, leaving 332 eligible participants. Although most physicians believe that neonates with bronchiolitis rarely have meningitis (PERC 141/161 (87.6%); PERUKI 154/171 (90%)) and feel comfortable diagnosing bronchiolitis in this group (PERC 136/161 (84.5%); PERUKI 143/171 (83.6%)), there was significant variation in the proportion who would be likely/very likely to perform an LP (PERC 100/161 (62.1%); PERUKI 15/171 (8.8%)) (p<0.0001). Practice in Canada, <10 years in practice and lack of comfort with diagnosing bronchiolitis represent multivariable predictors of LP; OR 23.7 (95% CI 11.7 to 47.9), 2.3 (95% CI 1.2 to 4.2) and 2.5 (95% CI 1.1 to 5.0), respectively. Rapid knowledge of respiratory syncytial virus positivity would decrease LP probability from 35.4% to 20.2%.

Conclusion Estimated probability of performing LPs and other interventions in otherwise healthy febrile neonates with bronchiolitis is highly variable between emergency physicians in Canada and the UK/Ireland. Network, <10 years in ED practice and comfort level with diagnosing bronchiolitis in newborns constitute independent predictors of the likelihood of LP performance.

  • clincial management
  • infectious diseases, viral
  • paediatric emergency med
  • research, clinical
  • respiratory, pneumonia/infections

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  • Contributors LS and SS conceived the study, wrote the study protocol, extracted data and wrote the manuscript. LS, SS and MDL supervised data extraction. MDL and DS drafted the manuscript. MDL and DR aided in study design. MDL, DR, DS and SS revised the manuscript for intellectual content. DS conducted the statistical analysis. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This study was approved by the Research Ethics Board at The Hospital for Sick Children in Toronto, Canada, REB file no. 100005229. It was also approved by both the PERC and PERUKI networks.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators The following PERUKI collaborators have kindly provided local site championship with this study: PERUKI - Addenbrooke’s Hospital, Cambridge: R Clay; Alder Hey Children’s Hospital, Liverpool: S Messahel; Barking, Havering & Redbridge University Hospitals NHS Foundation Trust: S Gomes; Birmingham Children’s Hospital: S Hartshorn; Bristol Royal Hospital for Children: N Creasey; Chelsea and Westminster Hospital, London: J Ross; Children’s Hospital for Wales, Cardiff: S Mullen; Cork University Hospital: R O’Sullivan; County Durham & Darlington NHS Foundation Trust: J Furness; Evelina Children’s Hospital, London: D Hall; Great North Children’s Hospital, Newcastle: M Anderson; Hull Royal Infirmary: R Toko; James Cook University Hospital, Middlesbrough: A Murad; King’s College Hospital, London: F Cantle; Leeds General Infirmary: H Mollard; Leicester Royal Infirmary: D Roland; Morriston Hospital, Swansea: C Dieppe; North Middlesex Hospital: C Clements; Nottingham Children’s Hospital: C Gough; Ormskirk & District General Hospital: S Gardner; Our Lady’s Children’s Hospital, Crumlin: M Barrett; Queen Alexandra Hospital, Portsmouth: C Vorwerk; Royal Alexandra Children’s Hospital, Brighton: M Lazner; Royal Belfast Hospital for Sick Children: JA Maney; Royal Derby Hospital: G Robinson; Royal Devon and Exeter Hospital: A Appelboam; Royal Free Hospital, London: F Taylor; Royal Hospital for Children, Glasgow: S Foster; Royal Hospital for Sick Children, Edinburgh: J Browning; Royal Manchester Children’s Hospital: K Potier; Royal United Hospital, Bath: N Zurick; Royal Wolverhampton NHS Trust: L Kehler; Sheffield Children’s Hospital: D Burke; St George’s Hospital, London: H Jarman; St Mary’s Hospital, London: N Thompson; Sunderland Royal Hospital: N Mullen; Temple Street Children’s University Hospital, Dublin: P Fitzpatrick; The Royal London Hospital: A Parikh; University College Hospital London: Y Baki; University Hospital Lewisham: A Alcock; University Hospital Southampton: J Bayreuther; Watford General Hospital: M Jacobs. We also wish to thank the PERC executive committee for their support of this study: PERC: Amy C Plint MD FRCP(C) (Past PERC Chair, Children’s Hospital of Eastern Ontario, ON, Canada), Stephen B Freedman MD FRCP(C) (PERC Chair, Alberta Children’s Hospital, AB, Canada), Roger Zemek MD FRCP(C) (Children’s Hospital of Eastern Ontario, ON, Canada), Vik Sabhaney (BC Children’s Hospital, Vancouver, BC, Canada), Quynh Doan MD FRCP(C) (BC Children’s Hospital, Vancouver, BC, Canada), Naveen Poonai MD FRCP(C) (London Health Sciences Centre Children’s Hospital, London, ON, Canada), Samina Ali MD FRCP(C) (Stollery Children’s Hospital, Edmonton, AB, Canada), Marie-Christine Auclair, R.N. (CHU Ste-Justine Hospital, Montreal, Quebec, Canada), Esli Osmanlliu MD FRCP(C) (Montreal Children’s Hospital, Quebec, Canada), Rebecca Emerton (Alberta Children’s Hospital, AB, Canada).

  • Patient consent for publication Not required.