Yi Li1, Raphael A Carandang1, Swetha Ade1, Julie Flahive1, Kate Daniello1. 1. Department of Neurology (YL, RAC, SA, KD), University of Massachusetts Medical School; Quantitative Health Sciences (JF), University of Massachusetts Medical School, Worcester; and Department of Neurology and Neurological Sciences (YL), Stanford University Medical Center, CA.
Abstract
BACKGROUND: Approximately 400,000 diagnostic lumbar punctures (LPs) are performed by neurologists yearly in the United States. There has been a transition from neurologists performing >40% of LPs 2 decades ago to now <15% of the time. High body mass index (BMI) is one of the key obstacles of LP for neurology residents, and the success rates drop to 58% when BMI is >35 kg/m2. METHODS: A prospective intervention study was conducted from March 2017 to March 2018 at an academic medical center. Patients were divided into ultrasound-guided LP or conventional LP. The primary outcome was the success rate of LP. The secondary outcome was the parameters regarding LP performance, the patients' feedback after procedures, and the residents' feedback about the learning modules. RESULTS: Eighty-two patients were enrolled with inclusion criteria of age >18 years, BMI ≥25 kg/m2, and able to give written informed consent. The ultrasound-guided LP group showed higher success rate (92.7% vs 68.3%, p < 0.05) and less duration of time (17.02 vs 37.63 minutes, p < 0.05) compared with the conventional LP group. It also showed advantages of decreased trials of needle insertions and redirections and reduced pain levels perceived by patients. CONCLUSIONS: This study suggests that using ultrasound to localize before LP could increase the LP success rate and improve other related LP outcomes in the overweight populations. Our study also provides evidence that brief, targeted teaching modules are feasible and effective for ultrasound-guided LP training. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with BMI ≥25 kg/m2 undergoing LP, ultrasound guidance increases the LP success rate.
BACKGROUND: Approximately 400,000 diagnostic lumbar punctures (LPs) are performed by neurologists yearly in the United States. There has been a transition from neurologists performing >40% of LPs 2 decades ago to now <15% of the time. High body mass index (BMI) is one of the key obstacles of LP for neurology residents, and the success rates drop to 58% when BMI is >35 kg/m2. METHODS: A prospective intervention study was conducted from March 2017 to March 2018 at an academic medical center. Patients were divided into ultrasound-guided LP or conventional LP. The primary outcome was the success rate of LP. The secondary outcome was the parameters regarding LP performance, the patients' feedback after procedures, and the residents' feedback about the learning modules. RESULTS: Eighty-two patients were enrolled with inclusion criteria of age >18 years, BMI ≥25 kg/m2, and able to give written informed consent. The ultrasound-guided LP group showed higher success rate (92.7% vs 68.3%, p < 0.05) and less duration of time (17.02 vs 37.63 minutes, p < 0.05) compared with the conventional LP group. It also showed advantages of decreased trials of needle insertions and redirections and reduced pain levels perceived by patients. CONCLUSIONS: This study suggests that using ultrasound to localize before LP could increase the LP success rate and improve other related LP outcomes in the overweight populations. Our study also provides evidence that brief, targeted teaching modules are feasible and effective for ultrasound-guided LP training. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with BMI ≥25 kg/m2 undergoing LP, ultrasound guidance increases the LP success rate.
Authors: Furqan Shaikh; Jack Brzezinski; Sarah Alexander; Cristian Arzola; Jose C A Carvalho; Joseph Beyene; Lillian Sung Journal: BMJ Date: 2013-03-26
Authors: Marie Ng; Tom Fleming; Margaret Robinson; Blake Thomson; Nicholas Graetz; Christopher Margono; Erin C Mullany; Stan Biryukov; Cristiana Abbafati; Semaw Ferede Abera; Jerry P Abraham; Niveen M E Abu-Rmeileh; Tom Achoki; Fadia S AlBuhairan; Zewdie A Alemu; Rafael Alfonso; Mohammed K Ali; Raghib Ali; Nelson Alvis Guzman; Walid Ammar; Palwasha Anwari; Amitava Banerjee; Simon Barquera; Sanjay Basu; Derrick A Bennett; Zulfiqar Bhutta; Jed Blore; Norberto Cabral; Ismael Campos Nonato; Jung-Chen Chang; Rajiv Chowdhury; Karen J Courville; Michael H Criqui; David K Cundiff; Kaustubh C Dabhadkar; Lalit Dandona; Adrian Davis; Anand Dayama; Samath D Dharmaratne; Eric L Ding; Adnan M Durrani; Alireza Esteghamati; Farshad Farzadfar; Derek F J Fay; Valery L Feigin; Abraham Flaxman; Mohammad H Forouzanfar; Atsushi Goto; Mark A Green; Rajeev Gupta; Nima Hafezi-Nejad; Graeme J Hankey; Heather C Harewood; Rasmus Havmoeller; Simon Hay; Lucia Hernandez; Abdullatif Husseini; Bulat T Idrisov; Nayu Ikeda; Farhad Islami; Eiman Jahangir; Simerjot K Jassal; Sun Ha Jee; Mona Jeffreys; Jost B Jonas; Edmond K Kabagambe; Shams Eldin Ali Hassan Khalifa; Andre Pascal Kengne; Yousef Saleh Khader; Young-Ho Khang; Daniel Kim; Ruth W Kimokoti; Jonas M Kinge; Yoshihiro Kokubo; Soewarta Kosen; Gene Kwan; Taavi Lai; Mall Leinsalu; Yichong Li; Xiaofeng Liang; Shiwei Liu; Giancarlo Logroscino; Paulo A Lotufo; Yuan Lu; Jixiang Ma; Nana Kwaku Mainoo; George A Mensah; Tony R Merriman; Ali H Mokdad; Joanna Moschandreas; Mohsen Naghavi; Aliya Naheed; Devina Nand; K M Venkat Narayan; Erica Leigh Nelson; Marian L Neuhouser; Muhammad Imran Nisar; Takayoshi Ohkubo; Samuel O Oti; Andrea Pedroza; Dorairaj Prabhakaran; Nobhojit Roy; Uchechukwu Sampson; Hyeyoung Seo; Sadaf G Sepanlou; Kenji Shibuya; Rahman Shiri; Ivy Shiue; Gitanjali M Singh; Jasvinder A Singh; Vegard Skirbekk; Nicolas J C Stapelberg; Lela Sturua; Bryan L Sykes; Martin Tobias; Bach X Tran; Leonardo Trasande; Hideaki Toyoshima; Steven van de Vijver; Tommi J Vasankari; J Lennert Veerman; Gustavo Velasquez-Melendez; Vasiliy Victorovich Vlassov; Stein Emil Vollset; Theo Vos; Claire Wang; XiaoRong Wang; Elisabete Weiderpass; Andrea Werdecker; Jonathan L Wright; Y Claire Yang; Hiroshi Yatsuya; Jihyun Yoon; Seok-Jun Yoon; Yong Zhao; Maigeng Zhou; Shankuan Zhu; Alan D Lopez; Christopher J L Murray; Emmanuela Gakidou Journal: Lancet Date: 2014-05-29 Impact factor: 79.321