Use of Atraumatic Spinal Needles Among Neurologists in the United States

Birnbach, David J.; Kuroda, Mph Maxine M.; Sternman, David; Thys, Daniel M.

doi:10.1046/j.1526-4610.2001.111006385.x

Cited by 43 publications

(41 citation statements)

References 22 publications

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“…The most common reasons given by neurologists for not using the atraumatic needle are nonavailability and expense. 4 There have been no formal decisionanalytic studies evaluating the costs associated with the use of each of these spinal needles. 5 The goal of this study was to determine whether the atraumatic or the cutting spinal needle is preferred from a cost perspective, taking into account the initial procedural costs and the costs associated with treatment of postlumbar puncture headache.…”

Section: Discussionmentioning

confidence: 99%

“…This is partially due to lack of availability of diagnostic lumbar puncture kits that contain the atraumatic needle, but also provides a backup cutting needle in case of insertion failure with the atraumatic needle. 4 Published literature provided the cost of the atraumatic spinal needle, including the introducer that accompanies the needle. 11 Lumbar puncture under fluoroscopy and epidural blood patch costs were determined from Medicare reimbursement rates (CPT codes 62270, 76005, 62273).…”

Section: Methods Model Overviewmentioning

confidence: 99%

“…Among neurologists who are aware of atraumatic needles, expense was often given as the reason for not using them. 4 Neurologists may have greatly overestimated the costs associated with using the atraumatic needle. Although use of the atrau- Abbreviations: CPT ϭ current procedural terminology; ED ϭ emergency department; LP ϭ lumbar puncture; PLPHA ϭ postlumbar puncture headache.…”

Section: Sensitivity Analysismentioning

confidence: 99%

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Cost comparison between the atraumatic and cutting lumbar puncture needles

Tung¹,

So²,

Lansberg³

2012

Neurology

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Objective: The aim of this study was to determine which type of spinal needle is preferred from a cost perspective, taking into account costs of the spinal needle and treatment of postlumbar puncture headache. Methods:A decision-analytic model was created to determine the cost of diagnostic lumbar punctures using atraumatic and cutting needles. We assumed a health care system perspective and based the analysis on the treatment of a patient facing event probabilities derived from prior studies. The economic outcome measure was the difference in estimated costs between the 2 needles. One-way and probabilistic sensitivity analyses tested the robustness of the model. Results:Lumbar puncture performed with the atraumatic needle is associated with an average cost savings of $26.07 per patient. Average total health care costs are $166.08 with the atraumatic needle, compared to $192.15 with the cutting needle. There is 94% certainty that the atraumatic needle is cost-saving compared to the cutting needle based on probabilistic sensitivity analysis. Use of the atraumatic needle over the cutting needle by neurologists alone may result in $10.4 million in cost savings to the US health care system per year. Conclusion:The atraumatic spinal needle is associated with an overall cost savings to the US health care system. The balance of costs and benefits favors the use of the atraumatic needle over the cutting needle for diagnostic lumbar puncture. Neurology ® 2012;78:109-113Every year approximately 400,000 diagnostic lumbar punctures are performed by neurologists in the United States. 1 Recent studies have shown that the "atraumatic," pencil-point Sprotte spinal needle is associated with a lower incidence of postlumbar puncture headache compared to the conventional "cutting" Quincke needle. 2,3 Although the use of the atraumatic needle is standard practice among anesthesiologists for spinal anesthesia, only 2% of neurologists routinely use atraumatic needles. The most common reasons given by neurologists for not using the atraumatic needle are nonavailability and expense. 4 There have been no formal decisionanalytic studies evaluating the costs associated with the use of each of these spinal needles. 5 The goal of this study was to determine whether the atraumatic or the cutting spinal needle is preferred from a cost perspective, taking into account the initial procedural costs and the costs associated with treatment of postlumbar puncture headache. METHODS Model overview.A decision-analytic model was created (TreeAge Software, Inc.) to determine the costs of diagnostic lumbar punctures with the atraumatic and cutting spinal needles ( figure 1). In the analysis, we estimated average health care costs of each alternative from the time of the lumbar puncture to the resolution of postlumbar puncture headache. Not experiencing a postlumbar puncture headache and resolution of postlumbar puncture headache are the absorbing states after which the patient is excluded from the model. No further costs incurred by the absorbing ...

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Section: Discussionmentioning

confidence: 99%

Section: Methods Model Overviewmentioning

confidence: 99%

Section: Sensitivity Analysismentioning

confidence: 99%

See 1 more Smart Citation

Cost comparison between the atraumatic and cutting lumbar puncture needles

Tung¹,

So²,

Lansberg³

2012

Neurology

View full text Add to dashboard Cite

show abstract

“…The most common reasons given by neurologists for not using the needle were not having knowledge of atraumatic needles, nonavailability of the needles, expense, slow flow, and difficulty of use. 3 The results of multiple studies have contradicted criticisms of increased technical difficulty, altered flow dynamics, and increased cost associated with the atraumatic needle. The atraumatic needle was recently shown to be cost-saving compared to the cutting needle.…”

mentioning

confidence: 99%

“…During these hour-long sessions, evidence was presented from previously published studies regarding the atraumatic needle, including decreased risk of PLPH, cost savings, ease of use, and flow dynamics. [2][3][4][5][6] Residents were given samples of the atraumatic needle (22-G Sprotte) to compare to the cutting needle (20-G Quincke). Residents also observed a lumbar puncture with the atraumatic needle performed on a lumbar puncture simulator and had the opportunity to practice on the simulator.…”

mentioning

confidence: 99%