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Ultrasound-Assisted Lumbar Punctures in Children: An Updated Systematic Review With Meta-Analysis
Agata Ćwiek1, Maciej Kołodziej1
1Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.
Insights
Point-of-care ultrasound (POCUS) significantly improves the success rate of lumbar puncture (LP) on the first attempt in children. This method also reduces the occurrence of traumatic LPs, making it a valuable tool for physicians.
Area of Science:
- Pediatric Medicine
- Medical Imaging
- Procedural Outcomes
Background:
- Lumbar puncture (LP) is a common pediatric procedure with high rates of failure and trauma.
- Point-of-care ultrasound (POCUS) is increasingly explored to enhance procedural success.
Approach:
- Systematic review of randomized control trials (RCTs) up to November 2022.
- Searched PubMed, Embase, and CENTRAL databases.
- Included 7 RCTs with 618 pediatric participants.
Key Points:
- POCUS-assisted LP achieved a 72% first-attempt success rate versus 59.6% in the standard group (Risk Difference: 13.0%).
- POCUS reduced traumatic LPs by 12% (Risk Difference: -12%).
- No significant difference in procedure duration was observed.
Conclusions:
- POCUS enhances first-attempt success rates for pediatric lumbar puncture.
- POCUS decreases the incidence of traumatic LPs in children.
- Routine use of POCUS for LPs is recommended, particularly for less experienced clinicians.
Context:
Lumbar puncture (LP) is a common procedure in children, but the rates of unsuccessful and traumatic LPs remain high. Point-of-care ultrasound (POCUS) has been proposed as a tool for improvement.
Objectives:
Our aim was to systematically review current evidence on the usefulness of POCUS assisted LP in children.
Data Sources:
PubMed, Embase, and the CENTRAL were searched up to November 2022.
Study Selection:
We searched for randomized control trials assessing the effectiveness of POCUS assisted LP in children.
Data Extraction:
Data were extracted by 2 reviewers independently.
Results:
Seven randomized control trials involving 618 participants were included. Overall, the first attempt POCUS assisted LP was successful in 72% compared with 59.6% in the standard group, regardless of the definition used. The calculated risk difference was 13.0% (95% confidence interval [CI]: 3% to 23%) I2:53%, odds ratio: 2.00 (95% CI: 1.13 to 3.53), I2: 45% and risk ratio:1.21 (95% CI: 1.01 to 1.44) I2:64%. Additionally, fewer traumatic LPs occurred in the US-assisted group, with a risk difference of -12% (95% CI: -0.22 to -0.03), odds ratio: 0.45 (95% CI: 0.26 to 0.78) and risk ratio: 0.53 (95% CI: 0.35 to 0.79). POCUS did not extend the duration of LP procedure with mean difference: -1.11 (95% CI: -2.88 to 0.66).
Conclusions:
POCUS improved the first attempt success rate and reduced the incidence of traumatic LPs compared with standard LP procedure in children. Therefore, if it is available, POCUS should be used routinely before every LP, especially when performed by less experienced physicians.
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