Ultrasound-assisted lumbar puncture more successful, less traumatic, less painful

Reference

Gottlieb M, Holladay D, Peksa GD. Ultrasound-assisted lumbar punctures: A systematic review and meta-analysis. Acad Emerg Med 2019;26(1):85-96.

Synopsis

Whether ultrasound-assisted LP is superior to the traditional landmark-based method is uncertain. These investigators thoroughly searched multiple databases, including PubMed, Scopus, CINAHL, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of relevant studies and review articles, as well as consulted with topic experts, to identify pertinent studies. Inclusion criteria consisted of randomized controlled trials that compared the success rates and complications of ultrasound-assisted LP with landmark-based LP. This review included both adult and pediatric patient populations without language restrictions. Two investigators independently assessed individual studies for eligibility criteria and methodologic quality using a standard scoring tool. Discrepancies were resolved by consensus agreement with a third reviewer. A total of 12 studies (N = 957 patients) met inclusion criteria, and the overall risk of bias was low. Ultrasound-assisted LP was significantly more successful than landmark-based LP for adults and children (90.0% vs 81.4%; number needed to treat = 11; 95% CI 6 - 83). No significant differences in success rate occurred between attending and resident physicians. There were also significantly fewer traumatic LPs with ultrasound-assisted compared with landmark-based methods (10.7% vs 26.5%; number needed to ultrasound = 6; 3 - 19). Finally; both the time to perform a successful LP and patient pain scores were significantly lower with the ultrasound-assisted method. A formal evaluation indicated minimal evidence of both publication bias and heterogeneity of the results.