Emergency physician performed ultrasound-assisted lumbar puncture in children: A randomized controlled trial.
Lumbar puncture
Pediatric
Ultrasound
Journal
The American journal of emergency medicine
ISSN: 1532-8171
Titre abrégé: Am J Emerg Med
Pays: United States
ID NLM: 8309942
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
25
10
2019
revised:
17
02
2020
accepted:
18
02
2020
pubmed:
25
3
2020
medline:
22
6
2021
entrez:
25
3
2020
Statut:
ppublish
Résumé
Lumbar puncture (LP) is one of the most common procedures performed in pediatric emergency departments but first-attempt success rates remain low and traumatic LP remains frequent. The aim of this study was to determine if ultrasound performed by emergency physicians improves the probability of first-attempt success for lumbar puncture in children. This was a prospective randomized controlled trial conducted in two tertiary care, pediatric, university-affiliated emergency departments in 2017-2018. Eligible participants were children younger than 19 years old requiring an LP in the emergency department. They were randomized to either the standard landmark-based LP (SLP) or ultrasound-assisted LP (UALP) groups. Our primary outcome was the first-attempt LP success rate. 166 patients were enrolled, with 84 in the UALP and 82 in the SLP group. A total of 23 physicians performed ultrasounds in the study. The proportion of successful first-attempt LP was higher in the ultrasound group (60/84; 68%) than for the standard procedure (52/82; 60%), but this failed to reach statistical significance (difference: 8.1%; 95% CI: -6.4 to 22.2). Our study does not support the routine use of ultrasound for performing lumbar puncture in children. Considering the minimal harm and ease of performance, ultrasound may be used as an adjunct and teaching tool in certain clinical situations.
Sections du résumé
BACKGROUND AND OBJECTIVE
Lumbar puncture (LP) is one of the most common procedures performed in pediatric emergency departments but first-attempt success rates remain low and traumatic LP remains frequent. The aim of this study was to determine if ultrasound performed by emergency physicians improves the probability of first-attempt success for lumbar puncture in children.
METHODS
This was a prospective randomized controlled trial conducted in two tertiary care, pediatric, university-affiliated emergency departments in 2017-2018. Eligible participants were children younger than 19 years old requiring an LP in the emergency department. They were randomized to either the standard landmark-based LP (SLP) or ultrasound-assisted LP (UALP) groups. Our primary outcome was the first-attempt LP success rate.
RESULTS
166 patients were enrolled, with 84 in the UALP and 82 in the SLP group. A total of 23 physicians performed ultrasounds in the study. The proportion of successful first-attempt LP was higher in the ultrasound group (60/84; 68%) than for the standard procedure (52/82; 60%), but this failed to reach statistical significance (difference: 8.1%; 95% CI: -6.4 to 22.2).
CONCLUSION
Our study does not support the routine use of ultrasound for performing lumbar puncture in children. Considering the minimal harm and ease of performance, ultrasound may be used as an adjunct and teaching tool in certain clinical situations.
Identifiants
pubmed: 32204980
pii: S0735-6757(20)30109-1
doi: 10.1016/j.ajem.2020.02.036
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
158-163Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors have no conflicts of interest relevant to this article to disclose.