Richards T J, Durieux J C, Nayate A P
From the Department of Radiology (T.J.R.), University of Utah School of Medicine, Salt Lake City, Utah.
Department of Radiology (J.C.D., A.P.N.), University Hospitals Cleveland Medical Center, University Hospitals, Cleveland, Ohio.
AJNR Am J Neuroradiol. 2022 Dec;43(12):1827-1833. doi: 10.3174/ajnr.A7684. Epub 2022 Nov 3.
Referrals to perform fluoroscopy-guided lumbar punctures by neuroradiologists have increased. The purpose of our study was to determine the management of fluoroscopy-guided lumbar puncture referrals in different practice settings.
We sent an online questionnaire to neuroradiologists and radiology trainees between May and June 2020 to survey their handling of fluoroscopy-guided lumbar puncture requests, preprocedural work-up, and the use of physician extenders/trainees to perform fluoroscopy-guided lumbar punctures, among other questions. Categories were compared using ORs.
Of the 123 US respondents, 81.3% were in combined academic and 18.7% in combined private practice groups. Regarding fluoroscopy-guided lumbar puncture referrals, 27.6% of respondents did not require a bedside lumbar puncture attempt before a fluoroscopy-guided lumbar puncture. Of private practice, 95.7%, and of academic respondents, 85.0%, were often asked to perform fluoroscopy-guided lumbar punctures by clinicians because of the clinician's lack of procedural competence. Of those, 74.8% stated that they always or sometimes agreed to the request. 41.5% of respondents stated that they would always comply with patients' requests for a fluoroscopy-guided lumbar puncture without a bedside lumbar puncture attempt, a 5.26 times higher likelihood (95% CI, 2.04-14.29) for private practice respondents. To perform fluoroscopy-guided lumbar punctures, 32.0% of academic respondents and 47.8% of private practice respondents use physician extenders. 75.0% of academic respondents reported that trainees perform >50% of their fluoroscopy-guided lumbar punctures.
This survey demonstrates that many academic and private practice neuroradiologists engage in practices that may promote an increase in fluoroscopy-guided lumbar puncture referrals including not requiring a non-image-guided lumbar puncture attempt, complying with clinicians' requests for a fluoroscopy-guided lumbar puncture due to lack of competence in performing lumbar punctures, and fulfilling patient requests for fluoroscopy-guided lumbar punctures.
神经放射科医生进行透视引导下腰椎穿刺的会诊量有所增加。我们研究的目的是确定在不同实践环境中对透视引导下腰椎穿刺会诊的管理方式。
2020年5月至6月，我们向神经放射科医生和放射科实习生发送了一份在线调查问卷，以调查他们对透视引导下腰椎穿刺请求的处理、术前检查以及使用医生助理/实习生进行透视引导下腰椎穿刺等问题。使用比值比（OR）对各分类进行比较。
在123名美国受访者中，81.3%来自学术与私人执业相结合的团体，18.7%来自纯私人执业团体。关于透视引导下腰椎穿刺会诊，27.6%的受访者在进行透视引导下腰椎穿刺前不要求先尝试床旁腰椎穿刺。在私人执业受访者中，95.7%，在学术受访者中，85.0%，经常因临床医生缺乏操作能力而被要求进行透视引导下腰椎穿刺。其中，74.8%表示他们总是或有时会同意该请求。41.5%的受访者表示他们会始终满足患者不进行床旁腰椎穿刺而直接进行透视引导下腰椎穿刺的请求，私人执业受访者的可能性高5.26倍（95%置信区间，2.04 - 14.29）。为进行透视引导下腰椎穿刺，32.0%的学术受访者和47.8%的私人执业受访者使用医生助理。75.0%的学术受访者报告称实习生进行了超过50%的透视引导下腰椎穿刺。
本次调查表明，许多学术和私人执业的神经放射科医生的做法可能会促使透视引导下腰椎穿刺会诊量增加，包括不要求进行非影像引导下的腰椎穿刺尝试、因临床医生腰椎穿刺操作能力不足而满足其进行透视引导下腰椎穿刺的请求以及满足患者进行透视引导下腰椎穿刺的请求。
