Majed Bilal, Zephir Hélène, Pichonnier-Cassagne Valérie, Yazdanpanah Yazdan, Lestavel Philippe, Valette Pierre, Vermersch Patrick
Emergency Medicine Department, Arras General Hospital, France.
Int J Emerg Med. 2009 Nov 19;2(4):227-35. doi: 10.1007/s12245-009-0128-5.
Lumbar punctures (LP) are regularly and effortlessly used in the emergency medical departments (EMD). LP use and efficiency have not been fully explored in the published literature.
The goal of this study was to assess in a French EMD, the frequency of use and the diagnostic efficiency of LP, the final diagnoses, and related medical practices.
We retrospectively studied all patients who underwent an LP after admission to our adult EMD in 2004 and 2005. Patients' medical files were reviewed to collect clinical and paraclinical features. We defined efficient LP as abnormal LP, which confirmed a suspected diagnosis in an emergency setting.
A total of 247 patients, representing 0.5% of all admissions, underwent an LP. LP were efficient in fewer than 15% of cases and confirmed aseptic meningitis (8.5%), bacterial meningitis (2.4%), Guillain-Barré syndromes (1.6%), subarachnoid hemorrhages (SAH, 0.4%), and carcinomatous meningitis (0.4%). The principal differential diagnoses were infections outside the central nervous system (CNS, 30%), noninfectious neurological disorders (28.7%), and benign headaches (14.2%). The main assumed LP indications were to search for CNS infection (62%) and for SAH (25%). LP efficiency decreased dramatically according to patients' age. Brain imaging was performed in 90% of patients prior to LP. Excessive use of polymerase chain reaction to detect herpes simplex in cerebrospinal fluid was observed. The only LP complications found were postdural puncture headaches (6.1% of cases). The rate of traumatic LP was 17%.
Our results are in accordance with the few published surveys on this topic. LP efficiency is modest but must be considered in light of the seriousness of suspected diagnoses. However, the search for differential diagnoses should not be neglected.
腰椎穿刺术（LP）在急诊科（EMD）经常被常规且轻松地使用。LP的使用情况及效率在已发表的文献中尚未得到充分探讨。
本研究的目的是在一家法国急诊科评估LP的使用频率、诊断效率、最终诊断结果及相关医疗实践。
我们回顾性研究了2004年和2005年入住我院成人急诊科后接受LP的所有患者。查阅患者病历以收集临床和辅助检查特征。我们将有效的LP定义为异常LP，即在急诊情况下证实了疑似诊断。
共有247例患者接受了LP，占所有入院患者的0.5%。LP在不到15%的病例中有效，确诊的疾病包括无菌性脑膜炎（8.5%）、细菌性脑膜炎（2.4%）、吉兰 - 巴雷综合征（1.6%）、蛛网膜下腔出血（SAH，0.4%）和癌性脑膜炎（0.4%）。主要的鉴别诊断包括中枢神经系统（CNS）以外的感染（30%）、非感染性神经系统疾病（28.7%）和良性头痛（14.2%）。主要假定的LP适应证是寻找CNS感染（62%）和SAH（25%）。LP的效率根据患者年龄显著降低。90%的患者在LP前进行了脑部成像。观察到在脑脊液中过度使用聚合酶链反应检测单纯疱疹病毒的情况。仅发现的LP并发症是腰穿后头痛（占病例的6.1%）。创伤性LP的发生率为17%。
我们的结果与关于该主题的少数已发表调查结果一致。LP的效率一般，但鉴于疑似诊断的严重性仍需考虑。然而，鉴别诊断的寻找不应被忽视。
