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

Abstract

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.

Real‐time detection of cerebrospinal fluid with bioimpedance needle in paediatric lumbar puncture

“…Computed tomography is also an option (Hudkins et al, 2017), but its clinical utility is compromised by the same issues as with fluoroscopy. Ultrasound does not involve X-ray radiation, and the ultrasound guidance can improve the success rate of performing a lumbar puncture and reduce the number of attempts, total puncture time and complications in neonates and infants (Muthusami et al, 2017;Olowoyeye et al, 2019). Again, besides the equipment, this method requires the physician's one hand to use the ultrasonic transducer and dedicated skills on mastering the transducer and interpreting the ultrasound image in real time.…”

Point-of-Care Ultrasound in the Pediatric Intensive Care Unit

“…It is a feasible approach to identifying landmarks and interspaces prior to performing the lumbar puncture ( 33 ). Ultrasound guidance increased the overall number of successful taps, while decreasing the number of traumatic taps, shortened the time to procedure completion, caused fewer needle passes and enhanced patient satisfaction ( 34 , 35 ). There was a high rate of procedural success even in patients where a previous lumbar puncture using landmarks approach had been previously attempted ( 36 ).…”

Clinical Progress Note: Point‐of‐Care Ultrasound for the Pediatric Hospitalist

“…Two recent meta‐analyses have investigated POCUS use for pediatric LPs 14,15 . Olowoyeye et al included four studies with a total of 277 patients and found that POCUS use was associated with a reduction in traumatic taps (risk ratio [RR] = 0.53, 95% C: 0.13‐0.82) when compared with landmark approaches 14 . However, there was no statistically significant reduction in LP failure, number of needle insertion attempts, or procedure length.…”