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Comparison of Ultrasound‐Guided and Landmark‐Based Lumbar Punctures in Inexperienced Resident Physicians
Author(s) -
Evans David P.,
Tozer Jordan,
Joyce Michael,
Vitto Michael J.
Publication year - 2019
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.14728
Subject(s) - medicine , lumbar puncture , lumbar , landmark , randomized controlled trial , emergency department , spinal puncture , anesthesia , cerebrospinal fluid , surgery , nursing , artificial intelligence , computer science
Objectives We sought to determine whether US‐guided lumbar puncture reduced the rate of lumbar puncture failures for providers at an academic teaching hospital with variable lumbar puncture and US experience compared to the traditional landmark‐based technique. Methods We conducted a prospective randomized controlled trial to compare US‐guided lumbar puncture to the traditional landmark technique in an academic emergency department. Thirty‐five patients were randomized to either have their lumbar puncture performed either via the landmark or US‐guided technique. All procedures were completed by an emergency medicine resident with variable lumbar puncture and US experience. Procedural failures, the number of attempts, the time to completion, and patient pain scores were all recorded. Results The adjusted odds ratio of successfully obtaining cerebrospinal fluid (CSF) in the US‐guided lumbar puncture group was 2.31 compared to the landmark‐based lumbar puncture group ( P = .377). It took 1.54 times more attempts to obtain CSF in the landmark group as it did in the US group ( P = .046). It seemed to have no effect on postprocedural pain or the time to obtain CSF. Conclusions The use of US guidance to assist in lumbar punctures did not improve the procedural success rate over traditional landmark techniques in an academic setting with novice providers. Although using US for procedural guidance significantly decreased the number of attempts, it seemed to have no effect on postprocedural pain or the time to obtain CSF.