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Emergency physician performed ultrasound-assisted lumbar puncture in children: A randomized controlled trial
Jaryd Zummer1, Marie-Pier Desjardins1, Jade Séguin2
1Department of Pediatric Emergency Medicine, CHU Sainte-Justine, Montreal, QC, Canada.
Insights
Ultrasound-assisted lumbar puncture (UALP) in children did not significantly improve first-attempt success rates compared to standard landmark-based procedures. While not routinely recommended, ultrasound may serve as a valuable adjunct and teaching tool in pediatric emergency care.
Area of Science:
- Pediatric Emergency Medicine
- Medical Ultrasound Applications
- Clinical Procedure Optimization
Background:
- Lumbar puncture (LP) is a common pediatric emergency department procedure.
- Low first-attempt success rates and frequent traumatic LPs are significant challenges.
- Improving LP success is crucial for effective pediatric patient care.
Purpose of the Study:
- To evaluate the efficacy of ultrasound-assisted lumbar puncture (UALP) performed by emergency physicians.
- To determine if UALP improves the first-attempt success rate in pediatric patients.
- To compare UALP with standard landmark-based lumbar puncture (SLP) in children.
Main Methods:
- Prospective randomized controlled trial in two pediatric emergency departments.
- 166 children under 19 years requiring LP were randomized to UALP or SLP.
- Primary outcome was the first-attempt success rate of lumbar puncture.
Main Results:
- First-attempt LP success was 68% in the UALP group (84 patients) and 60% in the SLP group (82 patients).
- The observed difference in success rates (8.1%) did not reach statistical significance (95% CI: -6.4 to 22.2).
- 23 physicians performed ultrasounds, indicating feasibility of training.
Conclusions:
- The study does not support the routine use of ultrasound for pediatric lumbar puncture.
- Ultrasound may be beneficial as an adjunct or teaching tool in specific clinical scenarios.
- Further research may explore targeted use of ultrasound in challenging pediatric LP cases.
Background And Objective:
Lumbar puncture (LP) is one of the most common procedures performed in pediatric emergency departments but first-attempt success rates remain low and traumatic LP remains frequent. The aim of this study was to determine if ultrasound performed by emergency physicians improves the probability of first-attempt success for lumbar puncture in children.
Methods:
This was a prospective randomized controlled trial conducted in two tertiary care, pediatric, university-affiliated emergency departments in 2017-2018. Eligible participants were children younger than 19 years old requiring an LP in the emergency department. They were randomized to either the standard landmark-based LP (SLP) or ultrasound-assisted LP (UALP) groups. Our primary outcome was the first-attempt LP success rate.
Results:
166 patients were enrolled, with 84 in the UALP and 82 in the SLP group. A total of 23 physicians performed ultrasounds in the study. The proportion of successful first-attempt LP was higher in the ultrasound group (60/84; 68%) than for the standard procedure (52/82; 60%), but this failed to reach statistical significance (difference: 8.1%; 95% CI: -6.4 to 22.2).
Conclusion:
Our study does not support the routine use of ultrasound for performing lumbar puncture in children. Considering the minimal harm and ease of performance, ultrasound may be used as an adjunct and teaching tool in certain clinical situations.
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