Ultrasound may best fluoro for guiding lumbar puncture in infants

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Fluoroscopy-guided lumbar puncture in infants has higher incidences of traumatic punctures in which red blood cells are introduced into the cerebrospinal fluid (CSF), according to a study in the March issue of the American Journal of Neuroradiology.

To minimize diagnostic confusion, a CSF specimen should be free from traumatically introduced red blood cells. The purpose of theresearch is to determine if patient age, sex, gauge of the lumbar puncture (LP) needle, or the level of LP is associated with an increased risk for traumatic fluoroscopy-guided LP.

Senior researcher Annette J. Johnson, MD, from Wake Forst University School of Medicine in Winston-Salem, N.C., and Samuel Yu, MD, from Indiana State University School of Medicine in Indianapolis retrospectively collected data for consecutive male and female patients of all ages who underwent a fluoroscopy-guided LP for a two-year period.

A traumatic LP was defined as one in which the RBC was 500 cells/mL or higher without xanthochromia.

According to the results, the rate of traumatic LP was 13.3 percent, and the rate of traumatic LP at the L4-L5 level carried a failure rate of 19 percent compared with 9 percent at the L2-L3 or 10 percent at the L3-L4 level. Patients older than 80 years had higher traumatic LP rates (25.9 percent) compared with patients between ages 11 and 80 years (12.4 percent). Sex and gauge of the spinal needle were not associated with increased rate of traumatic LP.

Patients younger than one year had failed LP rate of 58.8 percent compared with 3.2 percent failure rate in older patients. "The findings suggest that in infants, physicians may opt to use ultrasound to guide the needle for lumbar puncture or work without the cerebrospinal fluid altogether," Johnson said, according to Reuters Health.