The aim of this study is to determine if emergency physician performed ultrasound-assisted lumbar puncture improves first-time success rates in a pediatric population. This will be done by comparison with current landmark-based approach to the procedure.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
166
The ultrasound probe type will be selected by the treating pediatric emergency physician who has been trained according to standards outlined below. They will first identify the conus medullaris and make a horizontal marking with a sterile pen on the patient's back. Using a transverse view, they will then identify the midline of the patient's spine (using adjacent spinous processes) and will make 2 vertical skin markings on either side of the probe. Next, they will orient the probe in a longitudinal view to identify the desired vertebral interspace and will make 2 horizontal skin markings on either side of the probe at this level. Finally the 4 lines will be joined together at an intersection point, which will be the predetermined site for puncture attempt.
Sainte-Justine Hospital
Montreal, Quebec, Canada
First-tie success
First-time lumbar puncture success rate is defined by the presence of at least 0.5 mL of cerebrospinal fluid with red blood cell count \< 1,000/mm3.
Time frame: 15 minutes
Total lumbar puncture success rate
defined by the presence of at least 0.5 mL of cerebrospinal fluid with red blood cell count \< 1,000/mm3 in any number of attempt
Time frame: 15 minutes
Change in performer
If the lumbar puncture was attempted by a second person following the first attempts
Time frame: 15 minutes
Time of procedure
Time to perform the lumbar puncture
Time frame: 30 minutes
Complication
Occurence of any complication
Time frame: 30 minutes
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