Ultrasound assistance does not improve first-attempt non-traumatic lumbar puncture success in pediatric emergency settings compared with conventional methods, suggest findings published May 6 in the Journal of Pediatrics.
Researchers led by Jason Stoller, MD, and colleagues from Children’s Hospital of Philadelphia in Pennsylvania found no statistically significant difference in first-attempt non-traumatic success rates between infants in the NICU assigned to point-of-care ultrasound (POCUS)-assisted lumbar puncture and those assigned to the traditional landmark technique.
“In contrast, among proceduralists with prior ultrasound exposure, ultrasound assistance was associated with higher odds of success within two attempts, although these estimates were imprecise and based on small numbers,” Stoller and colleagues wrote.
Lumbar puncture is a critical diagnostic and therapeutic procedure in neonatal intensive care, but it is technically challenging. Prior research suggests that this approach is “frequently unsuccessful” and often needs repeated attempts.
POCUS can help identify spinal landmarks and estimate needle depth, with reports suggesting that ultrasound-assisted lumbar puncture could reduce traumatic taps and improve first-attempt success.
The Stoller team in a randomized controlled trial studied whether static ultrasound could improve first-attempt, non-traumatic lumbar puncture success compared with the traditional landmark technique in NICU patients. The study took place at a single tertiary-care NICU between 2016 and 2020. Infants ages six months or younger who needed lumbar puncture were randomized one-to-one to ultrasound-assisted or traditional landmark lumbar puncture.
Final analysis included 95 lumbar punctures performed in 91 infants by 16 proceduralists. First-attempt non-traumatic success occurred in half of procedures in both groups (odds ratio, 1.00; p = 1). Other procedural success outcomes did not differ between groups.
However, the ultrasound group experienced longer average procedure times (25.9 vs. 17.9 minutes; p = 0.002). The researchers also reported similar median antibiotic durations between both groups (eight days in both groups; p = 0.74).
The team also noted improved success with POCUS assistance within two attempts among novice proceduralists, though this benefit lessened as experience increased.
“Operator ultrasound experience also modified effectiveness, with improved success observed among proceduralists with prior ultrasound exposure,” the team wrote.
The results suggest that ultrasound may have value for training and early clinical practice, “rather than as a universal requirement for all proceduralists,” the study authors wrote.
They called for future validation studies to find out whether targeted implementation for inexperienced providers improves success rates and related outcomes.
“Trials restricted to proceduralists with substantial ultrasound experience may help clarify the impact of operator proficiency,” the authors wrote. "Separate studies are needed to determine whether dynamic ultrasound techniques enhance success and to identify the optimal timing for training in this approach.”
Read the full study here.
