Parental Attitudes and Knowledge About Lumbar Puncture in Children

Abstract

Objectives: Lumbar puncture (LP) is fundamental for diagnosis and treatment; however, some parents do not provide consent for their children to undergo the procedure, which can make diagnosis and determination of the optimal treatment difficult. The present study aimed to describe the level of knowledge and attitudes toward LP of parents whose children were scheduled to undergo the procedure.Methods: A prospective cross-sectional descriptive study of a convenience sample of parents of 84 children aged 2 months to 17 years scheduled for LP at a single academic children's hospital between 2015 and 2017. Parents were administered a written survey and interviewed by a physician other than the person who did the LP. Data on parental level of knowledge and attitudes regarding LP, in addition to reasons for refusal, were collected. The parents of 84 patients scheduled for LP due to various indications were administered a face-to-face survey interview. The survey was used to collect parental demographic data, as well as opinions and knowledge about LP and postinterventional complications. Results:The mean age of the 84 patients (57% male and 43% female) was 6.4 ± 5.17 years. Lumbar puncture was planned for the presumptive diagnosis of neurological disease in 45.25% of the patients, central nervous system infection in 45.25%, and acute encephalopathy in 9.5%. Among the parents, 65% (n = 55) had no knowledge or attitude about LP prior to the survey interview. The most common parental concern related to LP was paralysis (25%), followed by infertility (2%), mental retardation (1%), and disease progression (1%). Only 4.7% of the parents did not provide consent for their child to undergo LP. Conclusions:We found that most parents had little knowledge about LP, and the most common parental concern was paralysis. Despite this, in our study, only 5% of parents did not consent to LP.

Informed Refusal in Pediatric Practice: a Single Center Experience of a Tertiary Care Children’s Hospital

“…Although the rates of LP refusal tend to be lower in high-income countries, in several studies it was observed that LP refusal is not associated with economic status among individuals (26). The results of a very recent study showed that the rate of LP refusal among offered patients was only 5% in our country (27). During the study period, we do not know the number of patients offered LP in our hospital and thus, the results of this study do not reveal the rates of LP refusal among patients that were indicated for diagnostic/therapeutic purposes.…”

A qualitative study of patient, caregiver, doctor and nurse views of factors influencing lumbar puncture uptake in Zambia

“…[5][6][7] Literature examining reasons for low LP completion rates has predominantly focused on patient/caregiver refusal to provide LP consent due to limited knowledge. [8][9][10] LP-related knowledge and attitude surveys performed in Asia and the Middle East among healthy adults or relatives of children with febrile seizures suggest that understanding of LP is limited. 9,11,12 In northern Zambia and Botswana, adults reported concern that LP can cause death, but the relationship of this belief to LP uptake was not assessed.…”

“…[8][9][10] LP-related knowledge and attitude surveys performed in Asia and the Middle East among healthy adults or relatives of children with febrile seizures suggest that understanding of LP is limited. 9,11,12 In northern Zambia and Botswana, adults reported concern that LP can cause death, but the relationship of this belief to LP uptake was not assessed. 13,14 Health care workers (HCWs) have acknowledged heightened fear of death associated with LP in low-to-middle-income countries (LMICs), possibly as a result of misattribution of high mortality from opportunistic infections.…”

Public knowledge and attitude toward lumbar puncture among adults in Riyadh, Saudi Arabia: A cross-sectional study

“…9 Attitudes toward the LP procedure may vary, depending on cultural beliefs, geographical location, and knowledge levels. 1,5,10 Patients who refuse consent for LP procedures will be subjected to unwanted hospital admission or an increased hospital stay, both of which are associated with a risk of iatrogenic complications, as well as nosocomial infections. 1,7 Such patients may also receive unnecessary empirical antibiotic therapy, which may lead to an increase in antibiotic resistance.…”

“…4,7 Information on public knowledge of and attitudes toward LPs is needed to develop a suitable strategy to increase the LP consent rate. 10 The latter would result in a reduction in hospitalization cost and burdens on hospitals. Likewise, improving the acceptance level of LPs could reduce unnecessary complications resulting from improper management, thereby leading to a reduction in associated morbidity and mortality.…”