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Pain, position, and stylet styles: infant lumbar puncture practices of pediatric emergency attending physicians
Amy L Baxter1, J Camille Welch, Bonnie L Burke
1Division of Pediatric Emergency Medicine, University of Texas Southwestern, Children's Medical Center of Dallas, TX 75235, USA. amy.baxter@childrens.com
Insights
Pediatric emergency physicians rarely use analgesia for infant lumbar punctures (LPs), despite recommendations. Many also advance the needle without a stylet, indicating a need for improved training and practice.
Area of Science:
- Pediatric Emergency Medicine
- Medical Education
- Pain Management
Background:
- Lumbar punctures (LPs) are frequent procedures in pediatric emergency departments (EDs).
- Limited pediatric-specific research exists on LP training, practice guidelines, or optimal techniques for infants.
- Current analgesic use for infant LPs is not well-documented, especially since the introduction of topical anesthetics.
Purpose of the Study:
- To assess training and technique preferences among academic pediatric ED physicians.
- To determine the prevalence of analgesic use during infant LPs.
- To identify factors associated with analgesic use and practice changes.
Main Methods:
- A survey was distributed to 398 randomly selected physicians from the AAP Section on Pediatric Emergency Medicine.
- Physicians were surveyed via regular mail or email regarding their training, technique preferences, and analgesia use for LPs.
- Response rates differed significantly between survey formats, with regular mail yielding a higher response.
Main Results:
- A response rate of 52.4% (188 physicians) was achieved.
- Nearly one-third of physicians reported advancing the LP needle without the stylet.
- Two-thirds of physicians do not routinely administer analgesia for neonatal LPs.
- Physicians trained more recently were more likely to use analgesia, which was the most common practice change since residency.
Conclusions:
- Analgesia is underutilized in infant lumbar punctures.
- The practice of advancing the LP needle without a stylet is relatively common.
- Regular mail surveys demonstrated a significantly higher response rate compared to email surveys.
Objectives:
Lumbar punctures (LPs) are common emergency department (ED) procedures. Few pediatric studies exist to define training, guide practice, or indicate preferred methods for infants. While pain control is recommended, no recent studies indicate prevalence of analgesic use since the advent of topical anesthetics. We surveyed academic pediatric ED physicians to assess training and technique preferences and to highlight pain control usage.
Methods:
A total of 398 physicians were randomly selected from the 621 e-mail accessible members of the AAP Section on Pediatric Emergency Medicine. Questions concerning physician training, analgesia, and technique were either sent by regular mail or via e-mail link to a Web-based survey.
Results:
Of 359 deliverable surveys, there were 188 physician responses (52.4%) with differential response rates by survey format [58 e-mail (36%) and 130 regular mail responses (66%); P < 0.05]. Almost a third will advance the needle without the stylet in place. Two-thirds of physicians do not routinely use analgesia for neonatal LPs. Those using pain control were trained more recently (median 12 years vs. 15 years postresidency; P = 0.04). Analgesia use was the most common practice changed since residency.
Conclusions:
Analgesia is underused for infant LPs. Advancing the needle without a stylet is not uncommon. Response rate to regular mail surveys was much higher.
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