title: A positioning pillow to improve lumbar puncture success rate in paediatric haematology-oncology patients: a randomized controlled trial.
abstract: BACKGROUND
  Lumbar punctures (LPs) are common in children with cancer. Although pain management during the lumbar puncture has been well standardized, dealing with stress and anxiety is not well addressed yet. Our objective was to evaluate the potential improvement of the LP success rate using a positioning pillow, to ensure maximum lumbar flexion, and allow paravertebral muscles to relax, in children who are awake, with either conscious sedation or no sedation.
  
  
  METHODS
  Children aged 2-18 years undergoing LP were randomly assigned to a positioning pillow or no intervention. The primary outcome was the rate of success, i.e. achieving the LP (sampling or injection) at the first attempt, without bleeding (RBC < 50/mm3). The secondary outcomes included: the child's pain, assessed by a self-administered visual analogical scales (VAS) for children over 6 years of age; the parents' and caregivers' perception of the child's pain; the satisfaction of the children, the parents, the caregivers and the physician. The child's cooperation and the occurrence of post-LP syndrome were also evaluated.
  
  
  RESULTS
  124 children (62 in each group) were included. The LP pillow tended to increase the success rate of LPs (67% vs. 57%, p = 0.23), and decreased the post-LP syndromes (15% vs. 24%, p = 0.17) but the differences were not statistically significant. In children over 6-year of age (n = 72), the rate of success was significantly higher in the pillow group (58.5% vs. 41.5%, p = 0.031), with a tendency to feel less pain (median VAS 25 vs. 15 mm, p = 0.39) and being more satisfied (84.4% vs. 75.0%, p = 0.34).
  
  
  CONCLUSIONS
  Overall results do not demonstrate a benefit in using this pillow for lumbar punctures. This study results also suggest a benefit in the sub group of children over 6-year of age; this result needs confirmation.
authors.affiliation: Service d'Oncologie Pédiatrique, Institut d'Hémato-Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France. marec@lyon.fnclcc.fr
authors.forename: Perrine
authors.initials: P
authors.lastname: Marec-Bérard
authors.forename: Alvine
authors.initials: A
authors.lastname: Bissery
authors.forename: Kamila
authors.initials: K
authors.lastname: Kebaïli
authors.forename: Matthias
authors.initials: M
authors.lastname: Schell
authors.forename: Françoise
authors.initials: F
authors.lastname: Aubert
authors.forename: Ségolène
authors.initials: S
authors.lastname: Gaillard
authors.forename: Muriel
authors.initials: M
authors.lastname: Rabilloud
authors.forename: Behrouz
authors.initials: B
authors.lastname: Kassaï
authors.forename: Catherine
authors.initials: C
authors.lastname: Cornu
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006261:Headache / Q000209:etiology / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000175:diagnosis*; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D010290:Parents; D017060:Patient Satisfaction; D011187:Posture; D013129:Spinal Puncture / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*