The Variability of Preferred Infant Lumbar Puncture Insertion Site Between Novice and Experienced Physicians

Area of Science:

• Pediatric Emergency Medicine
• Medical Education
• Ultrasound-Guided Procedures

Background:

• Infant lumbar puncture (LP) is a common procedure in pediatric emergency medicine.
• Optimal vertebral interspace selection is crucial for safe and effective infant LP.
• Experience level may influence site selection for infant LP.

Purpose of the Study:

• To compare vertebral interspace selection for infant lumbar puncture between trainees and experienced pediatric emergency medicine (PEM) attending physicians.
• To assess the concordance of preferred insertion sites based on provider experience.
• To identify potential differences in anatomical landmark identification for infant LP.

Main Methods:

• Observational prospective study involving infants aged 0-12 months.
• Trainees with <10 infant LPs marked preferred sites with UV pens; PEM attendings marked with visible pens.
• Bedside ultrasound confirmed interspace concordance/discordance between marked sites.

Main Results:

• Trainee and attending LP interspace markings were concordant in only 27% of cases.
• Trainees selected insertion sites inferior to the attending physician's choice in 55% of patients.
• Trainees marked sites one to three levels below the attending's selection.

Conclusions:

• Significant variability exists in preferred lumbar puncture (LP) insertion sites based on provider experience.
• Less experienced trainees tend to select more caudal interspaces for infant LP compared to experienced PEM physicians.
• This difference in site selection may occur in an anatomical region with a smaller subarachnoid space, potentially affecting procedural outcomes.