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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:1341-1348 • 0278-4297

A Randomized Controlled Trial of Ultrasound-Assisted Lumbar Puncture

Jason T. Nomura, MD, Stephen J. Leech, MD, RDMS, Srikala Shenbagamurthi, MD, Paul R. Sierzenski, MD, RDMS, Robert E. O’Connor, MD, MPH, Melissa Bollinger, RN, Margaret Humphrey, RN and Jason A. Gukhool, MD, RDMS

Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware USA. Dr Leech is now with the Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida USA; Dr Shenbagamurthi is now with the Department of Emergency Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York USA; Dr Gukhool is now with the Division of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas USA.

Address correspondence to Jason T. Nomura, MD, Department of Emergency Medicine, Christiana Care Hospital, 4755 Ogletown-Stanton Rd, PO Box 6001, Newark, DE 19718 USA. E-mail: jnomura{at}comcast.net

Objective. Evidence showing the systematic utility of ultrasound imaging during lumbar puncture (LP) in the emergency department is lacking. Our hypothesis was that ultrasound-assisted LP would increase the success rate and ease of performing LP with a greater benefit in obese patients. Methods. This was an Institutional Review Board–approved, randomized, prospective, double-blind study conducted at the emergency department of a teaching institution. Patients undergoing LP from January to December 2004 were eligible for enrollment. Patients were randomized to undergo LP using palpation landmarks (PLs) or ultrasound landmarks (ULs). Data collected included age, body mass index, number of attempts, ease of performance and patient comfort on a 10-cm Visual Analog Scale, procedure time, success, and traumatic LP. Statistical analysis of data included relative risk (RR), the Mann-Whitney U test, and the Student t test. Results. A total of 46 patients were enrolled, 22 randomized to PLs and 24 to ULs. There were no differences between the groups in mean age or body mass index. Six of 22 attempts failed with PLs versus 1 of 24 with ULs (RR, 1.32; 95% confidence interval, 1.01–1.72). In 12 obese patients, 4 of 7 PL attempts failed versus 0 of 5 UL attempts (RR, 2.33; 95% confidence interval, 0.99–5.49). The ease of the procedure was better with ULs versus PLs. There were no statistical differences in the number of attempts, traumatic LPs, patient comfort, or procedure length. Conclusions. The use of ultrasound for LP significantly reduced the number of failures in all patients and improved the ease of the procedure in obese patients.

Key Words: body mass index • emergency ultrasound • interventional • obesity • spinal puncture • ultrasound

Abbreviations: BMI, body mass index • CI, confidence interval • CSF, cerebrospinal fluid • ED, emergency department • LP, lumbar puncture • PL, palpation landmark • RR, relative risk • UL, ultrasound landmark • VAS, Visual Analog Scale

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Copyright © 2007 by the American Institute of Ultrasound in Medicine.