Pediatric LP is a difficult procedure with a high failure rate, often due to lack
of provider experience [
[1]
,
[2]
]. Multiple attempts are often associated with patient discomfort and may complicate
cerebral spinal fluid (CSF) interpretation [
[3]
]. Unlike adult LPs, obesity is not often the etiology of procedural difficulty. Pediatric
LPs often require a more acute angle than adults, which also may contribute to novice
failure rates [
[4]
]. The sitting position does present some theoretical advantage as the width of the
subarachnoid space is significantly greater when infants are seated rather than lateral.
The seated position may also be better tolerated and potentially safer [
[5]
,
[6]
] as infant's experience (see Table 1, Table 2)fewer respiratory complications while seated [
[5]
]. Providers may also be more likely to obtain CSF on the first attempt in the seated
position [
[7]
,
[8]
]. Despite these potential benefits, the lateral position is more often selected by
providers [
[3]
,
[8]
]. While previous work with simulation training has shown improvement in pediatric
LP success rates in the clinical setting after training, the ideal initial approach
in the pediatric patient is unclear [
[9]
].
Table 1Demographic of study participants.
| Age – mean (SD), years | 24.4 (2.9) |
|---|---|
| Sex – male, n (%) | 14 (56) |
| Experience – year of medical school n (%) | |
| �1 | 17 (68) |
| �2 | 8 (32) |
Table 2Lumbar puncture outcomes by position.
| Sitting N = 25 |
Lateral N = 24 |
p-Value | |
|---|---|---|---|
| Median time, in seconds, spent performing LP (IQR) | 214 (51–300) | 52.5 (17–288.5) | 0.193 |
| Successful LP (%) | 18 (72) | 18 (75) | 0.812 |
| Median time, in seconds, to successful completion (IQR) | 105.5 (33–240) | 30 (14–78) | 0.096 |
| Median number of attempts (IQR) | 4 (2�10) | 2 (1–9) | 0.448 |
| First attempt success (%) |
6 (24) | 11 (46) | 0.109 |
IQR = Interquartile Range LP = lumbar puncture.
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Article Info
Publication History
Published online: April 07, 2018
Accepted:
April 6,
2018
Received in revised form:
April 5,
2018
Received:
January 25,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
