Is Lateral Decubitus or Upright Positioning Optimal for Lumbar Puncture Success in a Teaching Hospital?

Autor: Thundiyil JG; Department of Emergency, Orlando Regional Medical Center, Orlando Health, Orlando, Florida., O'Brien JF; Department of Emergency, Orlando Regional Medical Center, Orlando Health, Orlando, Florida., Tymkowicz AE; Department of Emergency, Orlando Regional Medical Center, Orlando Health, Orlando, Florida., Papa L; Department of Emergency, Orlando Regional Medical Center, Orlando Health, Orlando, Florida.
Jazyk: angličtina
Zdroj: The Journal of emergency medicine [J Emerg Med] 2023 Jan; Vol. 64 (1), pp. 14-21. Date of Electronic Publication: 2023 Jan 12.
DOI: 10.1016/j.jemermed.2022.09.002
Abstrakt: Background: Lumbar puncture is a common procedure performed by emergency physicians and trainees. The optimal patient positioning for lumbar puncture procedures has not been studied adequately.
Objectives: We performed a prospective randomized study in an urban, level I academic trauma center. Patients of all ages were included. Patients were randomized to either lateral decubitus or upright positioning. Patient demographic characteristics, level of physician training and experience, number of needle insertions and redirections, need for repositioning, alternative operator use, and laboratory results of the cerebrospinal fluid were recorded. We compared the success rate of each position as our primary outcome measure. We also evaluated number of needle insertions and re-directions and success rates based on experience and patient age.
Results: A total of 116 patients were enrolled, with 55 patients assigned to lateral decubitus and 61 to upright position for initial lumbar puncture attempt. Spinal fluid was obtained successfully in 47 of the lateral decubitus group (85.5%; 95% CI 73.8-92.4%) vs. 49 (80.3%; 95% CI 68.7-88.4%) in the upright assignment group. Comparable results were also obtained for first-pass success, number of failures, and number of bloody taps. Postgraduate year 2 residents or those with 31-50 previous lumbar punctures had the highest success rates at 94.3% (95% CI 81.2-98.4%) and 90.3% (95% CI 75.1-96.7%), respectively.
Conclusions: Lateral decubitus and upright positioning for emergency lumbar puncture yielded equal success rates in emergency physicians and trainees.
(Copyright © 2022. Published by Elsevier Inc.)
Databáze: MEDLINE
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