Ultrasound-assisted lumbar puncture in pediatric emergency medicine.
BACKGROUND
Ultrasound-assisted lumbar puncture in the pediatric emergency medicine setting has not been well established, but ultrasound could serve as a valuable tool in this setting.


OBJECTIVE
To assess whether ultrasound increases provider confidence in identifying an insertion point for lumbar puncture.


METHODS
A feasibility study was conducted using a convenience sample of pediatric emergency patients requiring lumbar puncture. Provider confidence in selecting a needle insertion site for lumbar puncture using ultrasound assistance was compared to provider confidence using traditional landmarks alone. A simple technique using a linear probe is described.


RESULTS
Nineteen patients were included in the study, with the primary end point the mean confidence score (based on a five-point Likert scale) in identifying a needle insertion site prior to and after using ultrasound. Using the Wilcoxon signed-rank test, the mean confidence score was 2.89 with the landmark procedure alone, and 4.79 with ultrasound assistance, yielding an average score difference of 1.90 (95% confidence interval 1.23-2.56; Wilcoxon p < 0.001, paired t-test p < 0.001). Thus, compared to the landmark procedure, the use of ultrasound was associated with a significantly higher average confidence score.


CONCLUSIONS
The use of ultrasound in the pediatric emergency setting can be a valuable adjunct with lumbar puncture.
Emergency Department, University of Rochester, Strong Memorial Hospital, Rochester, New York.
Stephen
S
Kim
Emergency Department, University of Rochester, Strong Memorial Hospital, Rochester, New York.
David K
DK
Adler
D059925:Anatomic Landmarks; D002675:Child, Preschool; D004635:Emergency Medicine; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010370:Pediatric Assistants; D020377:Self Efficacy; D013129:Spinal Puncture / Q000379:methods*; D011795:Surveys and Questionnaires; D018084:Ultrasonography, Interventional
emergency; lumbar puncture; pediatric; ultrasound