A Single Center Clinical Study Of CSF Results And Symptomatological Differential Diagnosis In Febrile Children With Convulsion

【Objective】To collect the auxiliary examination and clinical characteristics of febrile children with convulsion in order to provide evidence for clinical recognition of central nervous system infection.【Method】During January 2016 to December 2018,64 patients with fever and convulsion admitted to the Department of Neurology,Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University were collected retrospectively.According to the results of routine biochemical examination of cerebrospinal fluid(CSF),they were divided into two groups: CSF normal group(44 / 64 cases,69%)and CSF abnormal group(20 / 64 cases,31%).Their age,gender,clinical manifestation,physical symptoms of nervous system and auxiliary examinations between the two groups were compared by t-test or Mann-whiteney U test.The single factor exploratory analysis was conducted by χ 2 test and single factor Logistic regression analysis.The factors with P value less than 0.050 in the single factor analysis were selected for multivariate factor Logistic regression analysis to explore the independent risk factors of abnormal CSF results.【Result】According to our statistical analysis,the change of mental state(OR:P = 0.010),abnormal neurological signs(OR: 65.25,P = 0.023)and vomiting(OR:20.55,P = 0.048)were high risk factors of abnormal CSF results.By nonparametric the fever duration: glucose reduced groups [ 12.50(7.75-16.75)],glucose normal groups [ 4.00(3.00-5.75)];levels of CSF protein glucose reduced groups [3000(1745-3000)],glucose normal groups [ 648(469-1734)];ESR: glucose reduced groups [ 71.50(56.00-97.50)],glucose normal roups[ 20.50(12.00-26.00)];procalcitonin: glucose reduced groups[ 2.76(0.90-20.72)],glucose normal groups [ 0.23(0.03-1.00)];CRP :glucose reduced groups[123.00(33.00-177.75)],glucose normal groups[ 12.50(4.25-57.75)].we found that the fever duration,levels of CSF protein,ESR,procalcitonin and CRP were statistically different in CSF glucose normal and reduced groups(all P < 0.050).【Conclusion】In children with fever and convulsion,vomiting,mental state change,abnormal neurological signs are high risk factors of abnormal CSF results,suggesting that there may be central nervous system infection which needs early intervention.Meanwhile,to the children with abnormal CSF results,low level of CSF glucose may be a potential and powerful clue for purulent meningitis.