The influence of race on intraprocedural complication and side effect rates of lumbar punctures

Abstract

AbstractBackgroundA lumbar puncture (LP) is required to study cerebrospinal fluid (CSF) based biomarkers in preclinical Alzheimer’s Disease (AD). However, participants are often reluctant to undergo an LP due to fear. Insufficient data on the experiences of participants from underrepresented groups may contribute to their greater reluctance to agree to LP procedures, impacting diversity in AD studies. This analysis explores racial differences in intra‐procedural and post‐procedural complications rates.Methods870 LP procedures were performed on 606 participants in the Wisconsin Alzheimer's Disease Research Center, using a standardized technique with 24 or 25 gauge atraumatic needles. Up to 22 milliliters of CSF was obtained using gentle syringe aspiration of fluid. The clinician performing the procedure documented any intraprocedural complications experienced, including: headache, pain, vasovagal response, and radiculopathy. A follow‐up phone call the next day was used to assess any side effects following the procedure. Statistical analysis was performed using IBM‐SPSS version 27. Chi‐square tests were performed to compare complication rates between non‐Hispanic white, African American, and American Indian participants. Logistic regression analysis helped determine if BMI and waist‐to‐hip ratio also influenced complication rates.ResultsSample characteristics are shown in Table 1. LP success rates varied significantly by race (11.370, p=0.001). 90% of White, 77.5% of African American, and 66.6% of American Indian participants had a successful LP (Table 2); 61.1% of White, 48.8% of African American, and 52.4% of American Indian participants experienced zero complications (Figure 1). African American and American Indian participants experienced higher rates of total intraprocedural complications (9.642, p=0.022; 0.975, p=0.807 respectively). There was a significant group difference in reports of pain and headache during the procedure. However, few participants experienced any post‐procedural side effects. Overall, 5.5% experienced a headache and 8.5% experienced low back pain and no significant differences were seen between racial groups.ConclusionLPs are relatively safe with limited intraprocedural complications and few post‐procedural side effects. These results can help re‐evaluate potential disparities, alter LP procedures, and provide accurate information to potential participants to increase recruitment and study diversity.