Abstract
Objectives
The objective was to
determine if use of ultrasound (US) by emergency physicians (EPs) to localize
spinal landmarks improves the performance of lumbar puncture (LP).
Methods
This was a prospective,
randomized, controlled study conducted in a county teaching hospital. Subjects,
adults 18 years of age or older who were to receive LPs for routine clinical
care in the emergency department (ED), were randomized either to undergo US
localization of the puncture site or to have the puncture site determined by
palpation of spinal landmarks. Primary outcomes were the number of needle
insertion attempts and success of the procedure. Secondary outcomes were pain
associated with the procedure, time to perform the procedure, number of
traumatic taps, and patient satisfaction with the procedure.
Results
One-hundred patients were
enrolled in the study, with 50 in each study group. There were no significant
differences between the two groups in terms of age, sex, body mass index (BMI),
indication for LP, or ease of palpation of landmarks. For both primary outcomes
and secondary outcomes there were no significant differences between those
undergoing US localization and those with palpation alone.
Conclusions
These data do not suggest any
advantage to the routine use of US localization for LP insertion, although
further study may be warranted to look for benefit in the difficult to palpate
or obese patient subgroups.
