{"id":220,"date":"2011-11-16T21:55:32","date_gmt":"2011-11-16T20:55:32","guid":{"rendered":"https:\/\/blogs.bmj.com\/adc-archimedes\/?p=220"},"modified":"2013-02-27T14:45:33","modified_gmt":"2013-02-27T13:45:33","slug":"when-is-a-result-not-a-result","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/adc\/2011\/11\/16\/when-is-a-result-not-a-result\/","title":{"rendered":"When is a result not a result?"},"content":{"rendered":"

Hot on the heels of this great Archimedes<\/a> on whether or not you should routinely do an LP in infants with a urinary tract infection, comes another publication<\/a>, covered with a fairly critical review in Journal Watch<\/a>.
\nWhat’s fascinating here is both “sides” drawing a conclusion that they can’t draw.
\nThe authors took 392 infants aged 30 to 90 days who had had an LP, identified from a microbiology lab database, and found 57 who had evidence of a UTI. \u00a0They found that one of these 57 had disseminated sepsis. \u00a0They noted that this infant had other clinical features of sepsis, and conclude that routine LP is not needed in children aged 30 to 90 days who have UTI and no other features of sepsis.
\nHere’s where I think they go wrong: \u00a0They then go on to state that abnormal urinalysis has a negative predictive value for meningitis of 98.2%. \u00a0This might be arithmetically correct – I’ve not checked – but it is wrong to do. \u00a0The reason for this is that one of the groups contains just one patient, and you should be very careful of any statistical conclusion from just one patient. \u00a0What if this was the only patient from the next thousand? \u00a0Or what if it was the first of a series of ten patients about to turn up in the analysis?
\nIn Journal Watch, the commentator concludes the reverse is true; that the children aged 30 to 90 days with UTI remain at high risk and so should have LP. However, if we assume that this study has underestimated the numbers of menigitis even fourfold, that’s still 53 LPs that were\u00a0unnecessary. \u00a0Some of those – at some point – will cause harm.
\nWho should we believe? \u00a0The truth probably lies somewhere between the two, and may be articulated as follows:
\n– in children with UTI, the younger the child, the higher the risk of disseminated sepsis
\n– at very young ages, it is likely that a prescriptive rule of “always do an LP regardless of clinical signs” may be safest, but as children get older, clinical assessment should gain ascendency
\n– the conclusion from the Archimedes article, which is: “Between 0% and 2% of infants under the age of 3 months with urinary tract infection have co-existing bacterial meningitis” stands unchanged with this addition to the literature.<\/p>\n

My clinical bottom line? \u00a0Think about doing an LP. \u00a0Think very carefully, and then follow your clinical judgement, based on the clinical progress of the child.<\/p>\n","protected":false},"excerpt":{"rendered":"

Hot on the heels of this great Archimedes on whether or not you should routinely do an LP in infants with a urinary tract infection, comes another publication, covered with a fairly critical review in Journal Watch. What’s fascinating here is both “sides” drawing a conclusion that they can’t draw. […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[79,81,2245,160],"tags":[],"class_list":["post-220","post","type-post","status-publish","format-standard","hentry","category-archimedes","category-diagnostics","category-not-picket","category-uti"],"yoast_head":"\nWhen is a result not a result? - ADC Online Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/adc\/2011\/11\/16\/when-is-a-result-not-a-result\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"When is a result not a result? - ADC Online Blog\" \/>\n<meta property=\"og:description\" content=\"Hot on the heels of this great Archimedes on whether or not you should routinely do an LP in infants with a urinary tract infection, comes another publication, covered with a fairly critical review in Journal Watch. 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