title: Ultrasound guided lumbar puncture in emergency department: Time saving and less complications.
abstract: BACKGROUND
  Lumbar puncture (LP) is an essential procedure in the diagnosis and treatment of several critical situations. This procedure is routinely performed by palpating external landmarks to find the most appropriate inter-spinous space. In the current study, we compared surface landmark and ultrasound (US) guided LP in different aspects.
  
  
  METHODS
  This clinical trial study was conducted at the emergency department (ED) of a teaching hospital from March 2009 to March 2010. Eighty patients were allocated randomly in two equal groups. In first group, LP was performed by US-guided method and in the control group by palpation of external landmarks of spinal column. Pain score, number of attempts for successful dural penetration, numbers of traumatic LP, and procedure time were compared between two groups. The performance of US-guided LP was assessed with regard to body mass index (BMI) of patients too.
  
  
  RESULTS
  The mean of procedure time and pain scores were markedly higher in land mark group in comparison to US group (6.4 ± 1.2 and 7.4 ± 1.1 vs. 3.3 ± 1.2 and 4.4 ± 1.4 respectively). Number of attempts and number of traumatic LPs were significantly lower in US group too. In patients with different subgroups of BMI, US-guided LP showed better results and less complication when compared with surface landmark guided technique. All of these results were statistically significant.
  
  
  CONCLUSIONS
  This study showed that US was able to find pertinent landmarks to facilitate the LP in patients admitted to ED and resulted in less pain and less time wasting. Moreover, patients who have high BMI may benefit more than others.
authors.affiliation: Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mani
authors.initials: M
authors.lastname: Mofidi
authors.forename: Masoud
authors.initials: M
authors.lastname: Mohammadi
authors.forename: Hossein
authors.initials: H
authors.lastname: Saidi
authors.forename: Nahid
authors.initials: N
authors.lastname: Kianmehr
authors.forename: Ahmad
authors.initials: A
authors.lastname: Ghasemi
authors.forename: Peyman
authors.initials: P
authors.lastname: Hafezimoghadam
authors.forename: Mahdi
authors.initials: M
authors.lastname: Rezai
keywords: Complication; emergency department; lumbar puncture; ultrasound