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Age-related variations in opening pressure in lumbar puncture: Implications for its interpretation in children
Juan David Farfán-Albarracín1, Cristina Lorena Ramírez-Sierra2, Oscar Mauricio Espitia Segura3
1Red de Investigaciones Cualitativas y Cuantitativas en Neuropediatría (RICCNeP), Colombia; Unidad de Neuropediatría, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia; Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
Insights
Pediatric opening pressure during lumbar puncture increases with age, with 96 months identified as a key cutoff. These findings are crucial for diagnosing neurological conditions in children.
Area of Science:
- Neurology
- Pediatrics
- Clinical Measurement
Background:
- Opening pressure measurement during lumbar puncture (LP) is vital for diagnosing neurological disorders.
- Pediatric opening pressure values can differ based on age.
Purpose of the Study:
- To analyze the age-related variations in opening pressure during lumbar puncture in children.
- To identify significant age-related cutoff points for pediatric opening pressure.
Main Methods:
- Analysis of lumbar puncture data from February 2017 to March 2023.
- Exclusion of patients with factors influencing opening pressure.
- Application of descriptive statistics, regression analyses, and graphical methods to determine age-related trends and cutoff points.
Main Results:
- A median opening pressure of 21.0 cm H2O was observed across all pediatric patients.
- Opening pressure demonstrated a significant increase with age, with a notable cutoff point at 96 months.
- Children under 96 months had a median opening pressure of 19.2 cm H2O, while those older had a median of 22 cm H2O.
Conclusions:
- Pediatric opening pressure during lumbar puncture varies significantly with age, with no observed sex-based differences.
- The age of 96 months is a critical threshold for interpreting opening pressure values in children.
- Opening pressure alone is insufficient for diagnosing intracranial hypertension in pediatric patients, necessitating further diagnostic evaluation.
Introduction:
Opening pressure in lumbar puncture (LP) is an important parameter in the diagnosis of various neurological diseases. In children pressures may vary according to age. This study aimed to analyze the variation of opening pressure in LP according to age in children.
Methods:
All LPs performed between February 2017 and March 2023 were analyzed. Patients with modifying factors for opening pressure were excluded. Descriptive analysis was conducted, along with a comparison of means and medians, local regression, and quantile regression. To identify the most relevant cutoff points, graphical analyses were employed.
Results:
The median opening pressure was 21.0 cm H2O, with a 10th percentile (P10) of 10 and a 90th percentile (P90) of 32. An increase in opening pressure with age was found. Graphical analysis revealed a significant cutoff point at 96 months. The median opening pressure from 1 to 96 months of age was 19.2 cm H2O, with a P10 of 8 and a P90 of 28.9. For children older than 96 months, the median was 22 cm H2O, with a P10 of 11.8 and a P90 of 35.
Conclusion:
Opening pressures in children vary with age, with no differences related to sex. Graphical analysis indicates that 96 months of age is an important cutoff point. Above this age, standard values could be used, up to 96 months of age, however, it is necessary to conduct studies for reference values. Opening pressure alone is not sufficient for the diagnosis of intracranial hypertension in children.
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