Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis

Nath, Siddharth; Koziarz, Alex; Badhiwala, Jetan H.; Alhazzani, Waleed; Jaeschke, Roman; Sharma, Sunjay; Banfield, Laura; Shoamanesh, Ashkan; Singh, Sheila K.; Nassiri, Farshad; Oczkowski, Wieslaw; Belley‐Côté, Emilie P.; Truant, Ray; Reddy, Kesava; Meade, Maureen O.; Farrokhyar, Forough; Bała, Małgorzata M; Alshamsi, Fayez; Krag, Mette; Etxeandia-Ikobaltzeta, Itziar; Kunz, Regina; Nishida, Osamu; Matouk, Charles; Selim, Magdy; Rhodes, Andrew; Hawryluk, Gregory; Almenawer, Saleh A.

doi:10.1016/s0140-6736(17)32451-0

Cited by 140 publications

(160 citation statements)

References 32 publications

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“…We therefore included a discussion about different needle types and their consequences for the likelihood of one of the most common complications of LP, the postdural‐puncture headache in our seminar. Given the persistent widespread use of traumatic needles (Duits et al, ; Moisset et al, )—most likely the result of being passed down through a traditional top‐down teaching system (Tung, )—our seminar enabled us to demonstrate the advantages of atraumatic needles for diagnostic LP using convincing scientific data (Nath et al, ) and to teach the handling of the atraumatic approach from the very beginning. These interventions led to a remarkable increase in the students' knowledge about needle types, thereby setting the cornerstone for a primary atraumatic approach to LP.…”

Section: Discussionmentioning

confidence: 99%

Medical students' attitudes toward lumbar puncture—And how to change

2019

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Objective To survey medical students on the lumbar puncture (LP) procedure in terms of their existing knowledge, practical experience and attitudes, and to determine whether the completion of a single standardized seminar that includes practical training on phantoms can alter these parameters. Methods The survey was completed by medical students undertaking the curricular neurology course. Students were asked to describe their practical experience in different bedside procedures, and document how they perceive LP in terms of their own knowledge, confidence and attitude. Students then participated in a newly designed 90‐min seminar that included practical training on phantoms and placed special emphasis both on the patients' point of view during the procedure and the benefits of an atraumatic approach. All students who completed the seminar were required to complete the survey for a second time. Results Among the 153 participants, LP was associated with the lowest baseline levels of experience and confidence compared to other bedside procedures. Attitudes, knowledge, and confidence related to the various aspects of LP all showed significant improvement after the seminar. Conclusion A single standardized LP seminar with simulation training alters medical students' attitudes toward LP through improving their level of knowledge and confidence. This may have important implications in doctors‐to‐be on their stance toward LP and resultant advice to future patients regarding this important procedure.

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Section: Discussionmentioning

confidence: 99%

Medical students' attitudes toward lumbar puncture—And how to change

2019

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“…The overall safety record of lumbar puncture is strongly supported by extensive meta-analyses [76, 262]. However, fluid biomarkers are unable to reflect brain regional pathogeographies, which may be particularly important during early AD [47, 281].…”

Section: Introductionmentioning

confidence: 99%

Current state of Alzheimer’s fluid biomarkers

et al. 2018

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Alzheimer’s disease (AD) is a progressive neurodegenerative disease with a complex and heterogeneous pathophysiology. The number of people living with AD is predicted to increase; however, there are no disease-modifying therapies currently available and none have been successful in late-stage clinical trials. Fluid biomarkers measured in cerebrospinal fluid (CSF) or blood hold promise for enabling more effective drug development and establishing a more personalized medicine approach for AD diagnosis and treatment. Biomarkers used in drug development programmes should be qualified for a specific context of use (COU). These COUs include, but are not limited to, subject/patient selection, assessment of disease state and/or prognosis, assessment of mechanism of action, dose optimization, drug response monitoring, efficacy maximization, and toxicity/adverse reactions identification and minimization. The core AD CSF biomarkers Aβ42, t-tau, and p-tau are recognized by research guidelines for their diagnostic utility and are being considered for qualification for subject selection in clinical trials. However, there is a need to better understand their potential for other COUs, as well as identify additional fluid biomarkers reflecting other aspects of AD pathophysiology. Several novel fluid biomarkers have been proposed, but their role in AD pathology and their use as AD biomarkers have yet to be validated. In this review, we summarize some of the pathological mechanisms implicated in the sporadic AD and highlight the data for several established and novel fluid biomarkers (including BACE1, TREM2, YKL-40, IP-10, neurogranin, SNAP-25, synaptotagmin, α-synuclein, TDP-43, ferritin, VILIP-1, and NF-L) associated with each mechanism. We discuss the potential COUs for each biomarker.

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“…Post‐dural puncture headache (PDPH) is recognized by the International Classification of Headache Disorders, 3rd Edition (ICHD‐3), as a headache developing within 5 days of a dural puncture, with objective evidence of low cerebrospinal fluid (CSF) pressure . The incidence of PDPH is 11% (95% confidence interval (CI) 9.1‐13.3) when conventional needles are used compared with 4.2% (95% CI 3.3‐5.2) when atraumatic needles are utilized . Risk factors for PDPH include age, female sex, bevel orientation, and use of traumatic and/or larger bore needles .…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of PDPH is 11% (95% confidence interval (CI) 9.1‐13.3) when conventional needles are used compared with 4.2% (95% CI 3.3‐5.2) when atraumatic needles are utilized . Risk factors for PDPH include age, female sex, bevel orientation, and use of traumatic and/or larger bore needles . However, despite the concept of intracranial hypotension being recognized as part of the diagnostic criteria, the impact of cerebrospinal fluid pressure and volume indices (eg, opening pressure [OP]) on PDPH incidence is unclear …”

Section: Introductionmentioning

confidence: 99%

CSF Pressure, Volume, and Post‐Dural Puncture Headache: A Case‐Control Study and Systematic Review

et al. 2019

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Objectives (1) To perform a systematic literature review to evaluate associations between post‐dural puncture headache (PDPH) and opening pressure (OP), closing pressure (CP), and volume of cerebrospinal fluid (V) removed. (2) To perform a case‐control study to evaluate pressure‐volume index (PVI) as a novel risk factor for PDPH. Background According to the International Classification of Headache Diagnoses, 3rd Edition (ICHD‐3), the diagnosis of PDPH requires documentation of intracranial hypotension. However, this remains an unproven concept. Methods A systematic literature review was conducted, searching Cochrane Database of Systematic Reviews, Ovid EMBASE, OVID MEDLINE, Scopus, and Web of Science. Study inclusion required a comparison of headache incidence following a LP as a function of OP, CP, and/or V. A retrospective, case‐control study with 1:1 matching was conducted utilizing ICHD‐3 criteria. Patients with factors that could influence CSF pressure were excluded. Results In our case‐control study, we did not identify a paired difference in either median (95% CI) elastance (0.05 [−0.09, 0.11], P = .503) or PVI (4.53 [−7.98, 19.97], P = .678). We identified 22 references, evaluating V (n = 14), OP (n = 11), and/or CP (n = 4). There was no convincing evidence for an association of PDPH with either OP or CP. A minority of studies documenting an association with V included patients with high‐volume CSF removal, and/or stratified patients by the timing of the headache onset. Conclusions The overall risk of PDPH does not appear to be influenced by OP, CP, V or PVI. PDPH may be related to V in instances of high‐volume removal, and depend on the timing of outcome assessment. Future revision of criteria should consider the existence of immediate and delayed PDPH subtypes, and not presume intracranial hypotension as a mandatory feature.

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Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis

Cited by 140 publications

References 32 publications

Medical students' attitudes toward lumbar puncture—And how to change

Medical students' attitudes toward lumbar puncture—And how to change

Current state of Alzheimer’s fluid biomarkers

CSF Pressure, Volume, and Post‐Dural Puncture Headache: A Case‐Control Study and Systematic Review

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