Gorn Michael, Kunkov Sergey, Crain Ellen F
The Departments of Pediatrics and Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY.
The Department of Pediatrics and Emergency Medicine, Division of Pediatric Emergency Medicine School of Medicine and Health Sciences Center SUNY at Stony Brook, Stony Brook, NY.
Acad Emerg Med. 2017 Jan;24(1):6-12. doi: 10.1111/acem.13099.
The objective was to describe a novel ultrasound-assisted lumbar puncture (UALP) technique and to compare it to standard lumbar puncture (SLP) technique in infants.
A prospective, randomized, controlled study in infants 60 days old and younger undergoing a lumbar puncture (LP) in a pediatric emergency department. Patients with a spinal anomaly or ventriculoperitoneal shunt were excluded. Eligible infants were randomized to UALP or SLP. A spinal sonogram was performed on all patients by an investigator not involved in performing the LP. Spinal landmarks and maximum safe depth were identified for the UALP providers. Providers in the SLP group were blinded to sonographic measurements. A successful LP was defined as the collection of cerebrospinal fluid (CSF) with a red blood cell count of less than 10,000 cells/mm . Statistical analysis included chi-square, Mann-Whitney U-test, and number needed to treat (NNT).
Forty-three patients were enrolled, 21 in the UALP group and 22 in the SLP group. Prematurity, weight, length, provider experience, anesthesia use, stylet technique, and number of attempts were similar between groups. The median age in the UALP group was 38 days (interquartile range [IQR] = 33 days) versus 45 days (IQR = 19 days) in the SLP group (p = 0.02). CSF was obtained in all UALP subjects (100%) versus in 18 of 22 (82%) in the SLP group (p = 0.04); 20 (95%) UALP subjects versus 15 (68%) SLP subjects met our definition of success (p = 0.023). The odds ratio of successful LP using UALP technique was 9.33 (95% confidence interval [CI] = 1.034 to 84.026) and the NNT was 3.7 (95% CI = 2.02 to 24.18).
The UALP technique increases the rate of a successful LP in infants compared to standard technique.
描述一种新型超声辅助腰椎穿刺（UALP）技术，并将其与婴儿标准腰椎穿刺（SLP）技术进行比较。
在一家儿科急诊科对60日龄及以下接受腰椎穿刺（LP）的婴儿进行一项前瞻性、随机、对照研究。排除有脊柱异常或脑室腹腔分流术的患者。符合条件的婴儿被随机分为UALP组或SLP组。由不参与实施LP的研究人员对所有患者进行脊柱超声检查。为UALP实施者确定脊柱标志和最大安全深度。SLP组的实施者对超声测量结果不知情。成功的LP定义为采集到红细胞计数少于10,000个/mm³的脑脊液（CSF）。统计分析包括卡方检验、曼-惠特尼U检验和治疗所需人数（NNT）。
共纳入43例患者，UALP组21例，SLP组22例。两组之间的早产情况、体重、身长、实施者经验、麻醉使用、针芯技术和穿刺次数相似。UALP组的中位年龄为38天（四分位间距[IQR]=33天），而SLP组为45天（IQR=19天）（p=0.02）。所有UALP受试者（100%）均获取到CSF，而SLP组22例中有18例（82%）获取到CSF（p=0.04）；20例（95%）UALP受试者与15例（68%）SLP受试者符合我们的成功定义（p=0.023）。使用UALP技术成功进行LP的优势比为9.33（95%置信区间[CI]=1.034至84.026），NNT为3.7（95%CI=2.02至24.18）。
与标准技术相比，UALP技术提高了婴儿成功进行LP的几率。
