Preprocedural Ultrasound for Infant Lumbar Puncture: A Randomized Clinical Trial

Autor: Vartan Pahalyants, Joshua Kriger, David Kessler, Gerald Behr, Peter S. Dayan
Rok vydání: 2018
Předmět:
Zdroj: Academic Emergency Medicine. 25:1027-1034
ISSN: 1553-2712
1069-6563
DOI: 10.1111/acem.13429
Popis: BACKGROUND: Our purpose was to determine the potential effect of pre-procedural ultrasound to increase lumbar puncture (LP) success compared with standard palpation method. Further, we assessed feasibility of and clinician satisfaction with a standardized ultrasound protocol. METHODS: This prospective, two-arm, parallel group randomized trial was conducted in a single-center pediatric emergency department. We compared pre-procedural ultrasound vs. palpation method on success with infant LPs. Infants 0.05) between intervention and control groups (difference 3%; 95% CI -19% to 24%). There were no statistical differences between intervention and controls groups for secondary outcomes including the rate of traumatic LPs, number of attempts, and the duration of LP procedure. Most sonographers (84%) strongly agreed or agreed that the US protocol technically easy to perform, well tolerated by the patient (94%), well accepted by the family (100%), and well accepted by the LP procedural clinicians (99%). In the US group, the majority of clinicians who performed the LPs (68.4%) noted that the pre-procedural US influenced their behavior, most commonly helping with overall visualization at the selected interspace (28.9%) or prompting a change in interspace (26.3% higher, 5.3% lower). Seventy seven percent agreed or strongly agreed that they would like to use the technique again for their next LP. The mean ultrasound duration was 4.6 minutes. CONCLUSIONS: Pre-procedural US by did not improve the rates of first attempt success when compared with palpation method. Our results suggest ultrasound is feasible and well accepted, with a perceptible impact on care.
Databáze: OpenAIRE
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