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Report by Trevor Cummings, Emergency Medicine Resident
Checked by Jeffrey S Jones, MD, Emergency Medicine Research Director
Grand Rapids Medical Education & Research/Michigan State University, Michigan, USA
A short cut review was carried out to establish whether ultrasonography can assist in the performing of a lumbar puncture. Fifty‐one citations were reviewed of which three answered the three part question. The clinical bottom line is that ultrasound shows early promise as a tool to assist in achieving a successful lumbar puncture.
In [patients requiring lumbar puncture (LP)], is [ultrasonography assisted LP better than landmark technique] for [increasing chances of successful specimen collection]?
A patient presents to the emergency department with fever, headache, and neck stiffness. You feel a lumbar puncture is a neccessary part of the patients work up; can bedside ultrasonography assist in specimen collection?
Medline 1966‐05/07 using the OVID interface, Cochrane Library (2007), PubMed clinical queries: [(exp ultrsonography OR ultrasound.mp) AND (exp lumbar puncture OR lumbar puncture.mp)]. LIMIT to human AND English.
Fifty‐one papers found of which only three were relevant (table 11).).
All studies found ultrasound clinically useful. Two studies had similar design in that they were assessing ability to identify appropriate landmarks. However, their results should be considered preliminary as it may not translate into increased rates of success, diminished complication rates for the procedure, or other secondary end points related to lumbar puncture. Coley's study shows us that ultrasound can not only be used in real time for cerebrospinal fluid collection but can also be a tool to diagnose cause of failed collection and to identify those in which attempting collection may be futile.
Ultrasound shows early promise as a tool to assist in achieving a successful lumbar puncture.