Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.
Acad Emerg Med. 2019 Jan;26(1):85-96. doi: 10.1111/acem.13558. Epub 2018 Oct 3.
Lumbar punctures (LPs) are a common procedure in emergency medicine. However, studies have found that failed procedure rates can be as high as 50%. Ultrasound has been suggested to improve success rates by visually identifying the location and trajectory for the LP procedure. This systematic review and meta-analysis was performed to determine whether the use of ultrasound improved the rate of successful LP performance.
PubMed, CINAHL, Scopus, LILACS, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all randomized controlled trials comparing the success rates of ultrasound-assisted LP with landmark-based LP. Secondary outcomes included the rate of traumatic LPs, time to procedural success, number of needle passes, and patient pain score. Data were dual extracted into a predefined worksheet, and quality analysis was performed using the Cochrane Risk of Bias tool. Data were summarized and a meta-analysis was performed with subgroup analyses by pediatric versus adult patients and by operator training level.
Twelve studies (n = 957 total patients) were identified. Ultrasound-assisted LP was successful in 90.0% of patients and landmark-based LP was successful in 81.4% of patients. The calculated risk difference (RD) was 8.9% (95% confidence interval [CI] = 1.2% to 16.7%) with an odds ratio (OR) of 2.22 (95% CI = 1.03 to 4.77) in favor of the ultrasound-assisted group. There were fewer traumatic LPs in the ultrasound-assisted group (10.7% vs. 26.5%; RD = -16.4%, 95% CI = -27.6% to -5.2%; OR = 0.28, 95% CI = 0.18 to 0.45). Ultrasound-assisted LP was also associated with a shorter time to successful LP (6.87 minutes vs. 7.97 minutes), fewer mean needle passes (2.07 vs. 2.66), and lower patient pain scores (3.75 vs. 6.31).
Ultrasound-assisted LPs were associated with higher success rates, fewer traumatic LPs, shorter time to successful LP, fewer needle passes, and lower patient pain scores. Ultrasound should be considered prior to performing all LPs, especially in patients with difficult anatomy. Further studies are recommended to determine whether this effect is consistent in both adult and pediatric subgroups, as well as the impact of transducer type and body habitus on this technique.
腰椎穿刺（LP）是急诊医学中的常见操作。然而，研究发现，失败率可能高达 50%。超声检查可以通过视觉识别 LP 操作的位置和轨迹来提高成功率。本系统评价和荟萃分析旨在确定超声是否能提高 LP 操作的成功率。
通过 PubMed、CINAHL、Scopus、LILACS、Cochrane 系统评价数据库、Cochrane 对照试验中心注册库以及选定文章的参考文献，评估了所有比较超声辅助 LP 与基于地标 LP 的成功率的随机对照试验。次要结局包括创伤性 LP 的发生率、操作成功时间、针数和患者疼痛评分。数据由双人录入预定义工作表，使用 Cochrane 偏倚风险工具进行质量分析。汇总数据并进行荟萃分析，按儿科与成人患者和操作者培训水平进行亚组分析。
共纳入 12 项研究（共纳入 957 例患者）。超声辅助 LP 成功率为 90.0%，基于地标 LP 成功率为 81.4%。计算的风险差异（RD）为 8.9%（95%置信区间[CI]为 1.2%至 16.7%），超声辅助组的优势比（OR）为 2.22（95%CI为 1.03 至 4.77）。超声辅助组创伤性 LP 发生率较低（10.7% vs. 26.5%；RD=-16.4%，95%CI=-27.6%至-5.2%；OR=0.28，95%CI=0.18 至 0.45）。超声辅助 LP 还与 LP 操作成功时间更短（6.87 分钟 vs. 7.97 分钟）、平均针数更少（2.07 针 vs. 2.66 针）和患者疼痛评分更低（3.75 分 vs. 6.31 分）相关。
超声辅助 LP 与更高的成功率、更低的创伤性 LP 发生率、更短的 LP 操作成功时间、更少的针数和更低的患者疼痛评分相关。在进行所有 LP 操作前，应考虑使用超声检查，尤其是在解剖结构困难的患者中。建议进一步研究以确定这种效果在成人和儿科亚组中是否一致，以及换能器类型和体型对该技术的影响。
