Ultrasound-Assisted Lumbar Puncture in Pediatric Emergency Department
Emre Özdamar1, Ahmet Kağan Özkaya, Ekrem Güler
1From the Departments of *Pediatrics, and †Pediatric Emergency, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras; ‡Department of Pediatric Emergency, Faculty of Medicine, Gazi University, Ankara; and §Department of Radiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
Insights
Ultrasound-assisted lumbar puncture (LP) may reduce traumatic LPs and the number of attempts in children. While this study found a trend towards improvement, the results were not statistically significant.
Area of Science:
- Pediatric Emergency Medicine
- Medical Ultrasound Applications
- Diagnostic Procedures
Background:
- Lumbar puncture (LP) is a critical diagnostic tool in pediatric emergency settings.
- Ultrasound-assisted LP has shown promise in improving procedure success and reducing patient/parent anxiety.
- This study evaluates the impact of ultrasound guidance on LP outcomes in children.
Purpose of the Study:
- To assess the efficacy of ultrasound-assisted lumbar puncture (LP) compared to the conventional method.
- To determine the effect of ultrasound guidance on traumatic LP rates.
- To evaluate the impact on the number of puncture attempts in pediatric patients.
Main Methods:
- A randomized study comparing ultrasound-assisted LP with conventional LP in pediatric patients (<18 years) with suspected central nervous system infections.
- Patients were divided into odd (conventional) and even (ultrasound-assisted) groups.
- Outcomes measured included demographics, number of puncture attempts, and incidence of traumatic LP.
Main Results:
- Ultrasound-assisted LP was used in 56 patients; conventional LP in 55.
- Traumatic LP occurred in 8.9% of ultrasound-assisted cases versus 16.3% of conventional cases (P > 0.05).
- Multiple puncture attempts (≥2) were needed in 3.5% of ultrasound-assisted cases versus 9% of conventional cases (P > 0.05).
Conclusions:
- Ultrasound-assisted lumbar puncture demonstrated a trend towards reducing traumatic LPs and the number of puncture attempts in pediatric emergency services.
- These improvements did not reach statistical significance in this study.
- Further research may be warranted to confirm the benefits of ultrasound guidance in pediatric LP procedures.
Background:
Lumbar puncture (LP) is one of the essential diagnostic tools in pediatric emergency services. Recently, ultrasound-assisted LP was reported to be beneficial in the emergency service by facilitating the procedure and improving the successful procedure rates. In addition, this method may be effective in reducing patient and parent anxiety due to the LP procedure.
Objectives:
The aim of this study was to investigate the effect of ultrasound-assisted LP on the outcomes of puncture procedures and traumatic LP.
Methods:
The study included patients younger than 18 years, who were admitted to the pediatric emergency service and underwent LP because of suspected central nervous system infection. The patients requiring LP were randomly divided into 2 groups designated as odd and even. One group received LP using the conventional method, whereas the other group had LP after spinal space measurement by ultrasound. The patients who did and who did not undergo ultrasound-assisted LP were compared for demographics, number of puncture attempts, and traumatic LP. Statistical analysis was performed using the Mann-Whitney U test and the Student t test. The χ test was used when nominal data were compared between the 2 groups.
Results:
Ultrasound-assisted LP was performed in 56 patients, and LP by using conventional method was performed in 55 patients. There was traumatic LP in 5 (8.9%) of the patients who underwent ultrasound-assisted LP and 9 (16.3%) of the patients who underwent LP using the conventional method (P > 0.05). The number of puncture attempts was 2 or more in 2 (3.5%) of the patients who underwent ultrasound-assisted LP and 5 (9%) of the patients who had LP using the conventional method (P > 0.05).
Conclusions:
Ultrasound-assisted LP reduced traumatic LP and the number of puncture attempts in pediatric patients; however, the results were not statistically significant.
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