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The Champagne Tap: Time to Pop the Cork?
Author(s) -
Green Rebecca S.,
Cruz Andrea T.,
Freedman Stephen B.,
Fleming Alesia H.,
Balamuth Fran,
Pruitt Christopher M.,
Lyons Todd W.,
Okada Pamela J.,
Thompson Amy D.,
Mistry Rakesh D.,
Aronson Paul L.,
Nigrovic Lise E.
Publication year - 2020
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13966
Subject(s) - medicine , lumbar puncture , cerebrospinal fluid , white blood cell , confidence interval , emergency department , lumbar , complete blood count , anesthesia , surgery , psychiatry
Background A “champagne tap” is a lumbar puncture with no cerebrospinal fluid (CSF) red blood cells (RBCs). Clinicians disagree whether the absence of CSF white blood cells (WBCs) is also required. Aims As supervising providers frequently reward trainees after a champagne tap, we investigated how varying the definition impacted the frequency of trainee accolades. Materials & Methods We performed a secondary analysis of a retrospective cross‐sectional study of infants ≤60 days of age who had a CSF culture performed in the emergency department (ED) at one of 20 centers participating in a Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) endorsed study. Our primary outcomes were a champagne tap defined by either a CSF RBC count of 0 cells/mm 3 regardless of CSF WBC count or both CSF RBC and WBC counts of 0 cells/mm 3 . Results Of the 23,618 eligible encounters, 20,358 (86.2%) had both a CSF RBC and WBC count obtained. Overall, 3,147 (13.3%) had a CSF RBC count of 0 cells/mm 3 and 377 (1.6%) had both CSF WBC and RBC counts of 0 cells/mm 3 (relative rate 8.35, 95% confidence interval 7.51 to 9.27). Conclusions In infants, a lumbar puncture with a CSF RBC count of 0 cells/mm 3 regardless of the CSF WBC count occurred eight‐times more frequently than one with both CSF WBC and RBC counts of 0 cells/mm 3 . A broader champagne tap definition would allow more frequent recognition of procedural success, with the potential to foster a supportive community during medical training, potentially protecting against burnout.