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Medication Use in the Diagnostic Pediatric Lumbar Puncture
Vishal Naik1,2, Jing Jin3, Andrea Tinsay2
1Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Clinical Pediatrics
|August 27, 2022
Summary
Medication choice significantly impacts pediatric lumbar puncture (LP) success. Anesthesia like fentanyl, ketamine, and propofol improved outcomes, suggesting a need for standardized protocols in emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Anesthesiology
- Neurology
Background:
- Lumbar puncture (LP) is a frequent procedure in pediatric emergency settings.
- Current practices show considerable variability in medication use during pediatric LPs.
- The influence of medication on LP success is not well-established.
Purpose of the Study:
- To characterize medication administration during pediatric LPs.
- To determine if medication variations affect LP success rates.
- To identify specific medications associated with successful LPs.
Main Methods:
- Retrospective review of 2806 pediatric patients undergoing LPs from 2012-2016 across two children's hospitals.
- Analysis of medication use, patient demographics, procedural factors, and LP outcomes.
- Regression modeling to assess the association between medication and success, adjusting for confounders.
Main Results:
- Significant variation in medication use for pediatric LPs was observed.
- Fentanyl, ketamine, nitrous oxide, and propofol were associated with higher LP success rates after adjusting for covariates.
- Unsuccessful LPs were defined by documented failure, high cerebrospinal fluid red blood cell counts, or repeat procedures.
Conclusions:
- Provider choice of medication significantly influences pediatric lumbar puncture outcomes.
- The findings support the development of standardized medication protocols for pediatric LPs.
- Optimizing medication selection can improve procedural success and patient care.
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