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Lumbar puncture (LP) is a relatively common procedure in children, but, when it is unsuccessful or traumatic, patients might be subjected to unnecessary discomfort or antibiotic use. In a prospective observational study, investigators assessed factors associated with unsuccessful or traumatic LP at an urban pediatric emergency department.
Of 1459 LPs performed during the 19-month study period, 34% were traumatic (cerebrospinal fluid red blood cell count ≥10,000/mm3), and 1% were unsuccessful on the first attempt. In multivariate analysis, factors significantly associated with lack of success or trauma on the first attempt were patient movement (adjusted odds ratio, 2.1), lack of adequate analgesia (adjusted OR, 1.6), advancing the needle with the stylet in place (OR, 1.3), and less physician experience (adjusted OR, 1.08 for each decrease in the 6 categories of number of LPs performed, ranging from <5 to >100).
Nigrovic LE et al. Risk factors for traumatic or unsuccessful lumbar punctures in children. Ann Emerg Med 2007 Jun; 49:762-71.
Comment
This study supports others demonstrating that using adequate analgesia and advancing the needle through the dura (not the skin and associated tissues) without the stylet is associated with successful LP. The importance of lack of patient movement and of physician experience is obvious. When performing LP, physicians should use adequate analgesia and consider advancing the needle through the dura without the stylet.