Risk Factors for Traumatic or Unsuccessful Lumbar Punctures in Children

Impact of Just-in-Time and Just-in-Place Simulation on Intern Success With Infant Lumbar Puncture

“…Although all these variables are predictors of success in the literature, only early stylet removal was associated with success in our study across all 3 cohorts (P = .04). 31,32 Age of patients was also significantly associated with success (P , .001), but no difference was seen between cohorts. All the aforementioned variables were added in a stepwise fashion to a logistic regression model predicting infant LP success and did not uncover either a main effect for the study intervention or any significant interactions.…”

“…In this study, we report lower infant LP success rates (ranging from 34% to 42%) than previous descriptive reports of novice success rates (45%-63%). 32,33 These differences may reflect variations in definitions of success or populations studied. We set a high bar for success: a single, atraumatic attempt.…”

“…We set a high bar for success: a single, atraumatic attempt. 27 Although smaller studies have documented success using only laboratory results and not number of attempts, 32 we chose this patientcentered definition because success on the first attempt causes the least discomfort to patients. Other than our aforementioned single-center study, no research has demonstrated an intervention leading to improved clinical success with the infant LP procedure.…”

Lumbar Puncture of the Newborn

“…Causes include inserting the needle too far into an epidural venous plexus or through the subarachnoid space into or adjacent to the vertebral body. Nigrovic et al found that lack of local anesthetic use and advancement of the spinal needle with the stylet in place were most prominent risk factors for a traumatic LP [39]. In the study of Glatstein et al, its incidence was independent of physician experience, sedation use or time of procedure [40].…”

Adjustment of cerebrospinal fluid protein for red blood cells in neonates and young infants

“…Traumatic LPs occur in up to 30% of LPs performed in children. 1,2 In addition to affecting the CSF white blood cell count, the presence of CSF red blood cells (RBCs) is associated with higher CSF protein concentrations due to the higher protein concentration in plasma compared with CSF and to the release of protein from lysed red blood cells. CSF protein concentration has been used in clinical decision rules for the prediction of bacterial meningitis in children.…”