403 Are You Comfy? Comparing Success Rates of Lumbar Puncture Positions

Abstract

A lumbar puncture (LP) is commonly performed in the pediatric emergency department for diagnostic purposes; unsuccessful or traumatic LPs can complicate decision making. The sitting position has a larger interspinous space compared to lateral recumbent and is safer in sick neonates at risk for cardiac and respiratory instability. However, few studies have compared the effect of position on LP success and complication rates. The objective of our study was to determine if position affects success rates when performed in infants <3 months old. This is a retrospective chart review in infants aged <3 months who had a LP performed in a pediatric emergency department over a 35-month period. The primary outcome was the rate of successful LPs, defined as obtaining adequate CSF to send for studies. The secondary outcome was the rate of traumatic LPs, defined as >500 RBCs. Summary statistics were calculated and associations were examined using the Wilcoxon rank-sum and Fisher’s exact tests. A total of 557 charts were reviewed, with 116 in the sitting position and 441 in the lateral recumbent position. The primary outcome of adequate CSF fluid collection was not significantly different between groups (63% sitting position versus 58% lateral recumbent position; p = 0.22). In addition, the rate of traumatic LPs showed no significant difference (28% sitting position versus 27% lateral recumbent position; p = 0.84). In secondary analysis (Figure 1), there was a decreased number of LPs with no CSF in the sitting position (0.9%) versus the lateral recumbent position (3.9%), though not statistically significant (p = 0.10). Positioning during a LP in infants <3 months likely does not affect success rates or rates of traumatic LP.