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. 2020 Nov;27(11):1194-1198.
doi: 10.1111/acem.13966. Epub 2020 Apr 20.

The Champagne Tap: Time to Pop the Cork?

Rebecca S Green  1 , Andrea T Cruz  2 , Stephen B Freedman  3 , Alesia H Fleming  4 , Fran Balamuth  5 , Christopher M Pruitt  6 , Todd W Lyons  1 , Pamela J Okada  7 , Amy D Thompson  8 , Rakesh D Mistry  9 , Paul L Aronson  10 , Lise E Nigrovic  1 ; Herpes Simplex Virus Study Group of the Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC)
Affiliations

The Champagne Tap: Time to Pop the Cork?

Rebecca S Green et al. Acad Emerg Med. 2020 Nov.

Abstract

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/mm3 regardless of CSF WBC count or both CSF RBC and WBC counts of 0 cells/mm3 .

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/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).

Conclusions: In 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.

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References

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