Ultrasound-Assisted Lumbar Puncture in Infants: Success Rate of Diverse Providers Performing Both Procedures.

Abstract

Aim: Recent studies have reported the utility of performing an ultrasound examination before a lumbar puncture (LP) in infants. However, these studies involved different individuals performing each procedure, unlike the typical situation in the emergency department (ED) settings. This study aimed to determine the success rate of LP in infants when the same individuals within a diverse group of providers performed both procedures.

Methods: This prospective, observational study was conducted in the ED of a paediatric tertiary care hospital and included infants aged < 90 days. Physicians performed ultrasound before the LP, ensuring that the needle insertion did not exceed the measured distance to the ventral subarachnoid space. The primary outcome was the proportion of successful LPs, and the secondary outcomes included factors associated with the success of the procedure.

Results: Eighty patients were included. The proportion of successful LP was 68% (95% confidence interval [CI]: 57%-77%), which was comparable to that achieved using the standard palpation method. Multivariable analysis found a significant association of LP success with the absence of patients' movements (odds ratio [OR]: 6.40; 95% CI: 1.53-26.8) and procedures performed by attending physicians (OR: 12.3; 95% CI: 1.48-102).

Conclusions: Pre-LP ultrasound may not improve the success rate of LP in infants if performed by a diverse group of providers, even if the same providers perform both procedures. Factors such as minimising patients' movements and the providers' experience were significantly related to improving the LP success rate.