Parental Refusal to Lumbar Puncture: Effects on Treatment, Hospital Stay and Leave Against Medical Advice.

Abstract

IntroductionLumbar puncture (LP) is an effective method in the diagnosis and management of central nervous system infections. Refusal to LP is associated with severe consequences. This study aims to examine the impact of parental LP refusal on treatment, the length of hospital stay, and the frequency of patients leaving against medical advice (LAMA).MethodA cross-sectional study was conducted at the pediatric department of Civil Hospital, Karachi, from June 2018 to November 2019. All hospitalized patients suspected to have a central nervous system disease, which requires LP, were enrolled. Patients were followed for the duration of antibiotic and antiviral therapy, length of hospital stay, and LAMA.ResultsA total of 220 patients participated in the study, with the median age of nine (2-47) months. There were 113 (51.1%) males. The median length of hospital stay was 10 (4-14) days. The comparison of parental LP refusal with the length of hospital stay showed a significant difference (p-value <0.001) in the number of days of treatment among patients who received vancomycin (p-value =0.008) and meropenem (p-value =0.012). A significant association of parental LP refusal was also observed with meningoencephalitis and meningitis as provisional diagnosis (p-value =0.006). In particular, LAMA and death were found significantly higher among parents who refused LP (p-value <0.001). ConclusionLP refusal has a significant effect on the treatment, hospital stay, and disposition outcomes. A large number of parents who declined the procedure left against medical advice or suffered grave medical consequences. Parental education addressing their concerns and beliefs, while explaining the indications, and need for performing LP can help effectively overcome this issue.