Prospective evaluation of point-of-care ultrasound for pre-procedure identification of landmarks versus traditional palpation for lumbar puncture

doi:10.5847/wjem.j.1920-8642.2016.03.002

Abstract

Abstract:

BACKGROUND: The objective of this study is to determine if point-of-care ultrasound (POCUS) pre-procedure identification of landmarks can decrease failure rate, reduce procedural time, and decrease the number of needle redirections and reinsertions when performing a lumbar puncture (LP).
METHODS: This was a prospective, randomized controlled trial comparing POCUS pre-procedure identification of landmarks versus traditional palpation for LP in a cohort of patients in the emergency department and intensive care unit.
RESULTS: A total of 158 patients were enrolled. No significant difference was found in time to completion, needle re-direction, or needle re-insertion when using POCUS when compared to the traditional method of palpation.
CONCLUSION: Consistent with findings of previous studies, our data indicate that there was no observed benefit of using POCUS to identify pre-procedure landmarks when performing an LP.

Key words: Ultrasound, Lumbar puncture, Spinal tap

Shadi Lahham, Priel Schmalbach, Sean P. Wilson, Lori Ludeman, Mohammad Subeh, Jocelyn Chao, Nadeem Albadawi, Niki Mohammadi, John C. Fox. Prospective evaluation of point-of-care ultrasound for pre-procedure identification of landmarks versus traditional palpation for lumbar puncture[J]. World Journal of Emergency Medicine, 2016, 7(3): 173-177.

Figures/Tables 5

Figure 1.

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Figure 3.

Table 1

Table 2

References 21

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Characteristics	Sample size for variable	US (n=71)	Palpation (n=87)	P value
Age (year)	157	38 (31-49)	43 (32-53)	0.41
BMI (kg/m²)	157	25 (23-30)	27 (23-32)	0.19
BMI >30		25 (35)	20 (23)	0.11
BMI >40		6 (8)	4 (5)	0.35
Upright patient position		25 (36)	26 (30)
Recumbent patients position		45 (64)	60 (70)
History of prior back surgery	154	5 (7)	4 (5)	0.52

Outcomes	Sample size for variable	US (n=71)	Palpation (n=87)	P-value
Needle reinsertions	155	1 (0-3)	1 (0-4)	0.86
Needle redirections	155	4 (1-7)	4 (1-8)	0.94
Time to CSF (seconds)	136	195 (110-436)	181 (73-517)	0.38
Procedure unsuccessful	158	7 (10)	4 (5)	0.16

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