Background: Lumbar puncture (LP) is a common diagnostic procedure performed in emergency departments for febrile infants in order to rule in or rule out bacterial meningitis. A traditional LP procedure is accomplished by palpating for anatomical landmarks in order to place the needle in the correct location. Similar to venous catheterization, ultrasonography has been used as a non-invasive tool to locate these landmarks and mark their location on the skin of the patient. Several adult studies have been performed in order to analyze the success rate of traditional versus ultrasonography-assisted LPs and have shown increased success in the ultrasonography groups. The goal of this review is to analyze studies done on infants and discern if they have a similar or better success rate with ultrasonography assistance.
Methods: An exhaustive search of the literature was conducted on the following search engines: Web of Science, MEDLINE-Ovid, MEDLINE-PubMed, and Google Scholar. Key terms used included: ultrasonography, infant, lumbar puncture, and randomized control trial. All articles found went through an eligibility criteria and were analyzed using the GRADE assessment tool.
Results: Two randomized control trials were found to match the criteria. The first study included 128 infants with 64 in each group- traditional and ultrasound-assisted LPs. LP success rate within 3 attempts was 75% in the ultrasound-assisted group versus 44% in the traditional group. In the second study, 43 infants were enrolled with 21 infants in the ultrasound-assisted LP group and 22 in the traditional LP group. Final results showed a 95% success rate in the ultrasound group versus 68% in the traditional group.
Conclusion: Based on the articles analyzed, ultrasound-assisted LPs have higher success rates than traditional palpation of anatomical landmarks in the infant population. Increasing these success rates can help in reduction of healthcare cost, hospitalizations, and traumatic procedures. Overall, these studies are small, so there is still a need for larger randomized clinical trials in order to validate these findings further.
Keywords: Infant, ultrasonography, lumbar puncture, and ultrasound-assisted
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