Preprocedural Ultrasound for Infant Lumbar Puncture: A Randomized Clinical Trial

Kessler, David; Pahalyants, Vartan; Kriger, Joshua; Behr, Gerald; Dayan, Peter

doi:10.1111/acem.13429

Cited by 20 publications

(38 citation statements)

References 20 publications

(26 reference statements)

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“…One study26 was published as a reply to another study, but it had enough information about its methods for inclusion in this review. All the included studies were performed in paediatric emergency departments in the USA 23–26…”

Section: Resultsmentioning

confidence: 99%

“…Figure 2 shows the risk of bias summary and judgments about each risk of bias domain per included study. All studies used blocked randomisation 23–26. Two studies24 25 also concealed participant enrolment.…”

Section: Resultsmentioning

confidence: 99%

“…All studies used blocked randomisation 23–26. Two studies24 25 also concealed participant enrolment. Only one study23 was able to perform blinding of LP performers.…”

Section: Resultsmentioning

confidence: 99%

“…Ultrasound guidance would result in 5–18 fewer traumatic LPs in every 100 neonates and infants when compared with the palpation method as presented in table 2 and figure 4. The quality of this evidence was judged as moderate given there was some imprecision in the included studies.Needle insertion attempts: the studies23–26 looked at the number of needle attempts, and they found that there was no difference in both groups in terms of the number of attempts required to obtain CSF successfully during a diagnostic LP. Gorn et al 23 found that the number of attempts between the ultrasound and palpation groups were not significantly different.…”

Section: Explanationsmentioning

confidence: 99%

“…Most of the LPs performed in paediatrics are in neonates and infants. The few studies in this population have conflicting results on benefits of ultrasound imaging for paediatric LP that this review aims to address 23–26. The objective of this meta-analysis is to assess if ultrasound imaging increases the success of LP procedures and to assess any associated complications of the procedure when compared with the palpation method.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Ultrasound imaging versus palpation method for diagnostic lumbar puncture in neonates and infants: a systematic review and meta-analysis

Olowoyeye

Fadahunsi

Okudo

et al. 2019

bmjpo

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ImportanceLumbar puncture (LP) failure rates vary and can be as high as 65%. Ultrasound guidance could increase the success of performing LP.ObjectiveTo summarise the evidence on the use of ultrasound guidance versus palpation method for LP.Data sourcesWe searched computerised databases and published indexes, registries and references identified from bibliographies of pertinent articles without any language restrictions to find studies that compared ultrasound guidance to palpation method for performing an LP.Study selectionStudies were included if they were randomised or quasirandomised trials in neonates and infants that compared ultrasound guidance with palpation method for performing an LP.Data extraction and synthesisStandardised data collection tool was used for data extraction, and two reviewers independently assessed the quality of the studiesMain outcome(s) and measure(s)The primary outcome was the risk of LP failure, while the risk of traumatic tap, needle redirections/reinsertions and procedure durations were secondary outcomesResultsData from four studies and 308 participants is included in the analysis. Ultrasound imaging reduced the risk of LP failure, risk ratio of 0.58 (95% CI 0.15 to 2.28), but it was not statistically significant (p=0.44). Ultrasound imaging significantly reduced the risk of a traumatic tap risk ratio of 0.33 (95% CI 0.13 to 0.82) and p=0.02. The included studies had low to moderate quality; the studies differed based on mean age and with variability on outcome definition.Conclusions and relevanceThis meta-analysis suggests that ultrasound imaging has no effect in increasing lumbar success but is beneficial in reducing the risk of traumatic taps in neonates and infants.Trial registration numberCRD42017055800.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…All studies used blocked randomisation 23–26. Two studies24 25 also concealed participant enrolment. Only one study23 was able to perform blinding of LP performers.…”

Section: Resultsmentioning

confidence: 99%

Section: Explanationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Ultrasound imaging versus palpation method for diagnostic lumbar puncture in neonates and infants: a systematic review and meta-analysis

Olowoyeye

Fadahunsi

Okudo

et al. 2019

bmjpo

View full text Add to dashboard Cite

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Ultrasound-Guided Procedures Beyond Vascular Access

Wenger,

Chong

2023

Point-of-Care Ultrasound for the Neonatal and Pediatric Intensivist

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Lumbar puncture position in infants—a systematic review and meta-analysis

Kuitunen

Renko

2023

Eur J Pediatr

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To analyze the optimal lumbar puncture position in infants. A systematic review and meta-analysis. Infants (age < 1 year). December 2022 in PubMed, Scopus, and Web of Science. Randomized controlled trials focusing on lumbar puncture positions were included. Other lumbar puncture position than standard lateral decubitus position. First puncture success and overall success rate. Secondary outcome was desaturation during puncture and procedure-related harms. Risk of bias 2.0 assessment was performed. Outcomes are reported as risk ratios (RR) with 95% confidence intervals (CI). We screened 225 abstracts, and six studies were included. Four studies compared sitting position, one study head elevated lateral position, and one study prone position to lateral position. Risk of bias was high in two studies. First puncture success rate in sitting position (RR 1.00, CI: 0.78–1.18; 2 studies) and overall success rate in sitting position were similar to lateral position (RR 0.97, CI: 0.87–1.17; 3 studies). First attempt success rate was higher in elevated lateral position (RR 1.48, CI: 1.14–1.92; 1 study) and in prone position (RR 1.09, CI: 1.00–1.17; 1 study). Conclusion: Sitting position seems to be equally effective in terms of first attempt and overall success in lumbar puncture than standard lateral position. Elevated lateral position and prone positions had better first attempt success than standard lateral position, but these were assessed only in one study each and thus further studies in these positions are needed. Trial registration: This review was registered in PROSPERO. ID: CRD42022382953. What is Known:• Success rate in lumbar puncture has been poor and first attempt success rate has varied between 50 to 80% in literature.• Optimal lumbar puncture positions for infants have been debated between sitting and lateral decubitus position mostly. What is New:• This is the first meta-analysis focused on lumbar puncture positions in infants, and it found that sitting position was equal to standard lateral position.• Prone position and head elevated lateral positions had higher first puncture success rates, but these were assessed both only in one study, which creates uncertainty to the finding.

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Preprocedural Ultrasound for Infant Lumbar Puncture: A Randomized Clinical Trial

Abstract: Preprocedural US by did not improve the rates of first-attempt success when compared with palpation method. Our results suggest that US is feasible and well accepted, with a perceptible impact on care.

Cited by 20 publications

References 20 publications

Ultrasound imaging versus palpation method for diagnostic lumbar puncture in neonates and infants: a systematic review and meta-analysis

Ultrasound imaging versus palpation method for diagnostic lumbar puncture in neonates and infants: a systematic review and meta-analysis

Ultrasound-Guided Procedures Beyond Vascular Access

Lumbar puncture position in infants—a systematic review and meta-analysis

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