Fever
Conditions
Keywords
lumbar puncture, Point of care ultrasound, children
Brief summary
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.
Interventions
RADIATIONultrasound-assisted lumbar puncture
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.
Sponsors
St. Justine's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Years
Healthy volunteers
No
Inclusion criteria
* Patient less than 19 years of age * Requiring a lumbar puncture as part of their work-up, as determined by the treating pediatric emergency physician.
Exclusion criteria
* • Patients with known spine or spinal cord abnormalities * Patients with ventricular shunts * Patients deemed too unstable to have procedure performed * Patients at risk for significant bleeding (coagulopathy, thrombocytopenia, etc) * Parents unable to give consent or patients unable to assent for an acute reason
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| First-tie success | 15 minutes | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total lumbar puncture success rate | 15 minutes | 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 |
| Change in performer | 15 minutes | If the lumbar puncture was attempted by a second person following the first attempts |
| Time of procedure | 30 minutes | Time to perform the lumbar puncture |
| Complication | 30 minutes | Occurence of any complication |
Countries
Canada
Outcome results
None listed