title: Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic.
abstract: OBJECTIVE
  Post-lumbar puncture headaches (PLPHs) are a common complication of diagnostic lumbar punctures (LPs) caused by a persistent leak of spinal fluid from the dural puncture site. We conducted a prospective study to determine risk factors associated with PLPHs in the neurology outpatient setting.
  
  
  METHODS
  Clinical information from all diagnostic LPs performed at the Johns Hopkins Lumbar Puncture Clinic between September 2008 and June 2009 was reviewed. As standard of care, each patient was contacted by telephone by the attending physician within 2-5 days of having an LP to ascertain health status and the presence of PLPH. We performed multiple logistic regression analysis to evaluate the association between PLPH and needle type (traditional Quincke cutting needle 20 and 22 gauge, 20Q and 22Q, and Sprotte non-traumatic gauge 22 needle, 22S) adjusting for important variables such as traumatic LPs, number of attempts, positioning and volume of CSF drawn.
  
  
  RESULTS
  The prevalence of PLPH was 32% with the popular gauge 20Q and 22Q needles compared to 19% with the 22S non-traumatic needle. Compared to the 20Q needle, the non-traumatic 22S needle was associated with 69% decreased odds of PLPH (adjusted OR: 0.31, 95% CI 0.12-0.82). In subset analysis, the odds of PLPH increased 4-fold when the 22Q needle was used compared to the 22S needle (adjusted OR=3.99, 95% CI 1.32-12.0).
  
  
  CONCLUSIONS
  Our outpatient findings support the American Academy of Neurology recommendations to use smaller non-traumatic needles to reduce the risk of PLPH.
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287-5371, USA.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Hammond
authors.forename: Zhuangjun
authors.initials: Z
authors.lastname: Wang
authors.forename: Nihal
authors.initials: N
authors.lastname: Bhulani
authors.forename: Justin C
authors.initials: JC
authors.lastname: McArthur
authors.forename: Michael
authors.initials: M
authors.lastname: Levy
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D017217:Blood Patch, Epidural / Q000009:adverse effects; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects* / Q000145:classification*; D051299:Post-Dural Puncture Headache / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013129:Spinal Puncture / Q000009:adverse effects*; D055815:Young Adult