The Bottom Line: These studies shown increase success rate in lumbar punctures with the ultrasound in infants (6 months and younger) when used to identify the safe site (interspace with greatest CSF below conus) and measure the maximum safe depth.

Study 1: Gorn 2017

●      Prospective randomized controlled trial of 43 patients 60 days or younger in a pediatric ED in urban teaching hospital requiring LP.

●      20 of 21 patients in ultrasound assisted LP group successful (95%) vs 15 of 22 patients in standard LP group successful (68%), p = 0.023.

Limitations - unblinded, patients only enrolled if trained investigators (3) available (missed 25 patients), provider experience not provided in study.

Study 2: Neal 2017

●      Prospective randomized controlled trial of 128 patients 6 months or younger in a pediatric ED in teaching hospital requiring LP.

●      64 patient in each group - ultrasound assisted vs standard.

●      First attempt success greater in UALP (58%) than SLP (31%), ARR 27% CI 10-43%.

●      No significant difference in hospital length of stay and length of antibiotic treatment between groups.

Limitations - unblinded, patient sampling limited by sonographer availability, only standardization of LP technique with anesthesia use (not in patient positioning and stylet technique)

References:

1.     Gorn M, et al. Prospective Investigation of a Novel Ultrasound-assisted Lumbar Puncture Technique on Infants in the Pediatric Emergency Department. Academic Emergency Medicine. 2017;24:6-12.

2.     Neal J, et al. The Effect of Bedside Ultrasonographic Skin Marking on Infant Lumbar Puncture Success: A Randomized Controlled Trial. Annals of Emergency Medicine. 2017;69:610-19.