Daniel J. Pallin, MD, MPH reviewing Neal JT et al. Ann Emerg Med 2016 Nov 14.

Ultrasound-guided skin marking improved success in infant lumbar puncture.

Lumbar puncture (LP) is commonly performed in infants to rule out meningitis but is often not successful in the hands of inexperienced operators. Investigators at an academic pediatric emergency department randomized 128 infants younger than 6 months to traditional LP or LP preceded by ultrasound-guided skin marking of anatomic landmarks.

Ultrasound-guided marking was performed by one of three operators: a board-certified pediatric emergency physician with advanced ultrasound training, a senior resident, or a medical student. The resident and student completed an introductory ultrasound course and identified the landmarks successfully on at least five practice cases.

In the study, 54% of LPs were performed by operators with little or no LP experience. Of all LP first attempts, 98% were performed by trainees. LP success was defined as cerebrospinal fluid obtained with red blood cell count <1000/mm3.

First-attempt LP success was attained in 58% of infants in the ultrasound group versus 31% in the comparison group. Success within three attempts was attained in 75% versus 44% of infants, respectively. Success did not vary significantly by experience level of the LP operator or among the three sonographers. First-attempt success rates were 41% for operators who had performed <11 LPs and 52% for those who had performed ≥11 LPs, a nonsignificant difference.

CITATION(S):

Neal JT et al. The effect of bedside ultrasonographic skin marking on infant lumbar puncture success: A randomized controlled trial. Ann Emerg Med 2016 Nov 14; [e-pub]. 

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