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The Current Use of Lumbar Puncture in a General Paediatric Unit
S Coughlan1, M Elbadry1, M Salama1
1Dept. of Paediatrics, Mayo University Hospital.
Insights
Lumbar Puncture (LP) is crucial for diagnosing acute illnesses in children. Enhancing training for junior doctors in performing LPs is recommended to improve success rates and patient care.
Area of Science:
- Pediatrics
- Infectious Diseases
- Medical Procedures
Background:
- Lumbar Puncture (LP) is a key diagnostic tool in pediatric care.
- Evaluating the efficacy and safety of LP procedures in a general pediatric setting is essential.
Purpose of the Study:
- To assess the utilization and outcomes of Lumbar Puncture (LP) in a general pediatric unit over three years.
- To identify factors influencing LP success rates and procedural complications.
Main Methods:
- Retrospective review of 104 pediatric patients undergoing LP.
- Data collection included patient demographics, indication for LP, procedural outcome (atraumatic, traumatic, failed), and final diagnosis.
- Analysis of cerebrospinal fluid (CSF) and other culture results.
Main Results:
- LP was performed on 104 pediatric patients, including 29 neonates.
- Cerebrospinal fluid (CSF) was successfully obtained in 92.4% of cases, with 73.9% being atraumatic.
- Registrars performed the majority of successful LPs (86.5%), while 14.6% of patients had positive CSF cultures.
Conclusions:
- Lumbar Puncture (LP) remains a vital procedure for evaluating acute undifferentiated illnesses in pediatric patients.
- There is a need for improved training and support for less experienced doctors (SHOs) in performing LPs.
- Development of ancillary methods to enhance LP skills is desirable for pediatric units.
Abstract:
Aim This study evaluated the use of Lumbar Puncture (LP) in a general paediatric unit over a 3-year period. Methods Index patients, who had a successful LP, were identified from the microbiology database and failed LP procedures were identified from a chart review of the serum PCR database. Data abstracted included 1) patient age, 2) LP indication, 3) LP procedure outcome; classified as atraumatic, traumatic or failed, 4) grade of doctor undertaking the procedure and 5) the final diagnosis. Results We identified 104 paediatric patients, of whom 29(27.9%) were neonates. LP was indicated for the evaluation of acute undifferentiated illnesses, with 33 (31.7%) patients having fever without source beyond the neonatal period and 16 (15.4%) being neonates with fever. A CSF sample was obtained in 96 (92.4%) patients, with 71 (73.9%) being atraumatic. Successful LP was undertaken by Consultants in 4 (4.1%), Registrars in 83 (86.5%) and SHOs in 9 (9.4%) patients. 14 (14.6%) patients had positive CSF cultures with an additional 23 having positive cultures or serology (9 blood cultures, 11 urine cultures and 3 positive serum PCR). Conclusion Skill in LP performance is still required, to evaluate acute undifferentiated illness, in general paediatric units and ancillary methods to aid SHOs with LP skill development is desirable.
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