title: Patient position during lumbar puncture has no meaningful effect on cerebrospinal fluid opening pressure in children.
abstract: The recommendation to measure cerebrospinal fluid opening pressure in the extended, rather than the flexed lateral recumbent position to avoid false elevation of the opening pressure has not been formally evaluated in children. This single-center prospective cohort study includes 53 children who had their opening pressure measured in both the flexed and extended lateral recumbent positions prior to removing any cerebrospinal fluid (mean age = 11.7 years; 60% male). The mean opening pressure was higher in the flexed (25.1 +/- 9.2 cm H2O) compared with the extended (24.4 +/- 8.4 cm H2O) position (mean difference = 0.6 +/- 2.2 cm H2O; Z = 2.021, P < .03). Most (92.4%) opening pressure measurements had less than a 5 cm H2O difference between positions. Lumbar puncture performed in the extended, rather than the flexed lateral recumbent position results in a statistically significant decrease in cerebrospinal fluid opening pressure, although the magnitude of the difference is small and of doubtful clinical significance.
authors.affiliation: Division of Neurology, Children's Hospital of Philadelphia, Pennsylvania 19104-4399, USA. averyr@email.chop.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Avery
authors.forename: Rakesh D
authors.initials: RD
authors.lastname: Mistry
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Jan
authors.initials: J
authors.lastname: Boswinkel
authors.forename: Jimmy W
authors.initials: JW
authors.lastname: Huh
authors.forename: Michael D
authors.initials: MD
authors.lastname: Ruppe
authors.forename: Santiago
authors.initials: S
authors.lastname: Borasino
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Seiden
authors.forename: Grant T
authors.initials: GT
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D015170:Cerebrospinal Fluid Pressure; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D011446:Prospective Studies; D013129:Spinal Puncture / Q000379:methods*