From the Department of Neurology, University of Iowa Carver College of Medicine, Iowa City.
Neurology. 2015 Mar 10;84(10):e69-72. doi: 10.1212/WNL.0000000000001335.
To identify factors influencing the success of lumbar puncture (LP) performed by neurology residents in an outpatient clinic.
There is a need to understand the specific influence of patient or operator characteristics in LP performance in order to identify situations at high risk for failure that could benefit from compensatory interventions.
We performed a retrospective analysis of all consecutive patients who underwent elective LP in the Neurology Clinic at the University of Iowa between 2009 and 2012. We recorded demographic, anthropometric, and clinical information, and the level of training of the resident performing the procedure. Outcomes measure was unsuccessful LP, defined as no quantifiable CSF. This study was previously approved by the University of Iowa institutional review board.
A total of 328 patients (59% women) were included. Men were significantly older than women, and the indication of the procedure differed by sex. Headache or possible multiple sclerosis were more common indications in women than in men. Nineteen percent of the LPs were unsuccessful. We found a strong correlation between patient body mass index (BMI) and unsuccessful outcome (p < 0.0001). Age of the patient and level of training of the operator did not predict unsuccessful LP.
Patient BMI is the key factor that determines an unsuccessful LP by neurology residents in an outpatient setting, an association that might be applicable to different clinical settings. The high failure rate in patients with BMI >35 suggests that implementing compensatory interventions such as the use of imaging guidance might be cost-effective and better tolerated by these patients.
确定影响神经内科住院医师在门诊行腰椎穿刺（LP）成功率的因素。
需要了解患者或操作者特征对 LP 操作的具体影响，以便确定可能因代偿干预而失败的高风险情况。
我们对 2009 年至 2012 年间在爱荷华大学神经病学诊所行择期 LP 的所有连续患者进行了回顾性分析。我们记录了人口统计学、人体测量学和临床信息，以及行该操作的住院医师的培训水平。结局指标为 LP 不成功，定义为无定量 CSF。该研究先前已获得爱荷华大学机构审查委员会的批准。
共纳入 328 例患者（59%为女性）。男性明显比女性年长，且手术指征因性别而异。头痛或可能的多发性硬化症在女性中比在男性中更为常见。19%的 LP 不成功。我们发现患者体重指数（BMI）与不良结局之间存在很强的相关性（p < 0.0001）。患者年龄和操作者的培训水平均不能预测 LP 不成功。
患者 BMI 是神经内科住院医师在门诊行 LP 不成功的关键因素，这种关联可能适用于不同的临床环境。BMI >35 的患者失败率较高，这表明实施补偿性干预措施（如使用影像学引导）可能具有成本效益，并且这些患者更容易耐受。
