• Rebecca S Green, Andrea T Cruz, Stephen B Freedman, Alesia H Fleming, Fran Balamuth, Christopher M Pruitt, Todd W Lyons, Pamela J Okada, Amy D Thompson, Rakesh D Mistry, Paul L Aronson, Lise E Nigrovic, and Herpes Simplex Virus Study Group of the Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC).
• From, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
• Acad Emerg Med. 2020 Nov 1; 27 (11): 1194-1198.

BackgroundA "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.AimsAs supervising providers frequently reward trainees after a champagne tap, we investigated how varying the definition impacted the frequency of trainee accolades.Materials & MethodsWe 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/mm3 regardless of CSF WBC count or both CSF RBC and WBC counts of 0 cells/mm3 .ResultsOf 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/mm3 and 377 (1.6%) had both CSF WBC and RBC counts of 0 cells/mm3 (relative rate 8.35, 95% confidence interval 7.51 to 9.27).ConclusionsIn infants, a lumbar puncture with a CSF RBC count of 0 cells/mm3 regardless of the CSF WBC count occurred eight-times more frequently than one with both CSF WBC and RBC counts of 0 cells/mm3 . 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.© 2020 by the Society for Academic Emergency Medicine.

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