Trends in lumbar puncture utilization across a health system and in emergency department practice

Lumbar puncture (LP) remains a core emergency department (ED) procedure, though recent trends suggest a shift toward non-ED specialties. Within ED practice, trends in LP indications and procedural success are not well characterized.

To evaluate longitudinal trends in LP procedural volume across departments within a tertiary care health system and to characterize trends in ED LP indications, success rates, and variables associated with success.

We conducted a retrospective study at a single academic health system. LP volumes across clinical departments were assessed for calendar years (CYs) 2012-2024 using Poisson regression with incidence rate ratios (IRRs). ED-specific analyses included LPs performed from CYs 2014-2024, with temporal trends in indications evaluated using IRRs and multivariable logistic regression used to identify factors associated with LP success.

Radiology performed the greatest number of LPs from 2012 to 2024, with a 4.4% annual increase (IRR 1.044, 95% CI 1.036-1.052). ED LP volume declined by 1.5% annually (IRR 0.985, 95% CI 0.972-0.999). A total of 1117 LPs were performed in the ED from 2014 to 2024 (mean 106 annually), with success decreasing from 93.1% to 76.3%. LPs for subarachnoid hemorrhage declined (IRR 0.78/year, p < 0.001), while those for idiopathic intracranial hypertension (IIH) increased (IRR 1.29/year, p < 0.001). Upright positioning was independently associated with higher odds of success compared with lateral decubitus (OR 2.2, 95% CI 1.2-4.0).

LP volume shifted toward non-ED specialties, particularly Radiology, Internal Medicine, and Pediatrics. Within ED LP practice, indications shifted toward IIH and upright positioning was associated with greater LP procedural success.