Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.
Hosp Pediatr. 2024 Mar 1;14(3):209-215. doi: 10.1542/hpeds.2023-007480.
Lumbar puncture (LP) is a common procedure in children, but the rates of unsuccessful and traumatic LPs remain high. Point-of-care ultrasound (POCUS) has been proposed as a tool for improvement.
Our aim was to systematically review current evidence on the usefulness of POCUS assisted LP in children.
PubMed, Embase, and the CENTRAL were searched up to November 2022.
We searched for randomized control trials assessing the effectiveness of POCUS assisted LP in children.
Data were extracted by 2 reviewers independently.
Seven randomized control trials involving 618 participants were included. Overall, the first attempt POCUS assisted LP was successful in 72% compared with 59.6% in the standard group, regardless of the definition used. The calculated risk difference was 13.0% (95% confidence interval [CI]: 3% to 23%) I2:53%, odds ratio: 2.00 (95% CI: 1.13 to 3.53), I2: 45% and risk ratio:1.21 (95% CI: 1.01 to 1.44) I2:64%. Additionally, fewer traumatic LPs occurred in the US-assisted group, with a risk difference of -12% (95% CI: -0.22 to -0.03), odds ratio: 0.45 (95% CI: 0.26 to 0.78) and risk ratio: 0.53 (95% CI: 0.35 to 0.79). POCUS did not extend the duration of LP procedure with mean difference: -1.11 (95% CI: -2.88 to 0.66).
POCUS improved the first attempt success rate and reduced the incidence of traumatic LPs compared with standard LP procedure in children. Therefore, if it is available, POCUS should be used routinely before every LP, especially when performed by less experienced physicians.
腰椎穿刺（LP）在儿童中是一种常见的操作，但不成功和创伤性 LP 的发生率仍然很高。床边超声（POCUS）已被提议作为一种改进方法。
我们旨在系统地回顾目前关于 POCUS 辅助 LP 在儿童中的应用效果的证据。
PubMed、Embase 和 CENTRAL 数据库截至 2022 年 11 月的文献进行了检索。
我们检索了评估 POCUS 辅助 LP 在儿童中的有效性的随机对照试验。
由 2 名评审员独立提取数据。
共纳入了 7 项涉及 618 名参与者的随机对照试验。无论使用何种定义，POCUS 辅助 LP 的首次尝试成功率均为 72%，而标准组为 59.6%。计算得出的风险差异为 13.0%（95%CI：3%至 23%），I²：53%，比值比：2.00（95%CI：1.13 至 3.53），I²：45%和风险比：1.21（95%CI：1.01 至 1.44），I²：64%。此外，在 POCUS 辅助组中，较少发生创伤性 LP，风险差异为-12%（95%CI：-0.22 至-0.03），比值比：0.45（95%CI：0.26 至 0.78）和风险比：0.53（95%CI：0.35 至 0.79）。POCUS 并没有延长 LP 操作的时间，平均差值为-1.11（95%CI：-2.88 至 0.66）。
与标准 LP 操作相比，POCUS 提高了首次尝试的成功率，并降低了儿童创伤性 LP 的发生率。因此，如果有条件，应在每次 LP 前常规使用 POCUS，尤其是在经验较少的医生进行 LP 时。
