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Ultrasound-Assisted Lumbar Puncture in Children: A Meta-Analysis
Insights
Ultrasound-assisted lumbar puncture may improve first puncture success rates in infants, but not older children. More high-quality evidence is needed to confirm benefits for overall success rates in pediatric patients.
Area of Science:
- Pediatric Medicine
- Medical Imaging
- Interventional Procedures
Background:
- Lumbar puncture success rates in children are often low.
- Ultrasound guidance is a potential method to improve lumbar puncture success.
Approach:
- Systematic review and meta-analysis of randomized controlled trials.
- Searched PubMed, Scopus, and Web of Science databases.
- Included studies comparing ultrasound-assisted to palpation-marked lumbar puncture in children.
Key Points:
- First puncture success rate was higher with ultrasound (71.7%) versus palpation (58.9%) in children.
- Ultrasound demonstrated improved first puncture success in infants (RR 1.41) but not older children (RR 1.07).
- Overall success rates showed no significant difference between ultrasound and palpation groups.
Conclusions:
- The quality of evidence is low due to risk of bias and imprecision.
- Ultrasound may enhance first puncture success in infants, but its benefit in older children is uncertain.
- Further high-quality research is required before widespread implementation of ultrasound guidance for pediatric lumbar puncture.
Context:
Success rates of lumbar puncture are rather low in children. Ultrasound guidance has been suggested to increase success rate.
Objective:
To systematically compare lumbar puncture success with and without ultrasound in children.
Data Sources:
PubMed, Scopus, and Web of Science databases were searched in January 2023.
Study Selection:
Randomized controlled trials including children (aged <18 years) and comparing ultrasound-assisted lumbar puncture to palpation-marked lumbar puncture were included.
Data Extraction:
One author extracted, and the other author validated data.
Results:
Seven studies were included. First puncture success rate was 71.7% (190 of 265) in the ultrasound group and 58.9% (155 of 263) in the palpation group (risk ratio [RR], 1.22; (confidence interval [CI], 1.00-1.50; 5 studies). First puncture success rate with ultrasound was higher in infants (RR, 1.41; CI, 1.10-1.80; 3 studies), but not in older children (RR, 1.07; CI, 0.98-1.17; 2 studies). Overall success rate was 89.3% (276 of 309) in the ultrasound group and 80.3% (248 of 309) in the palpation group (RR, 1.11; CI 0.95-1.30; 7 studies).
Limitations:
Evidence quality was rated low because of risk of bias (3 studies high risk of bias) and imprecision.
Conclusions:
Ultrasound use may improve first puncture success rate in infants but not in older children. We did not find evidence of difference in overall success rate. Better quality evidence is needed before implementing ultrasound guidance in practice.
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