29 To cradle or not to cradle: Can the use of a lumbar puncture cradle increase lumbar puncture success rates?
Notice bibliographique
Résumé
Abstract Background Lumbar puncture (LP) has low published success rates, ranging between 50-80% in the neonatal and infant population, while traumatic taps are reported in 30-50%. Proper immobilization and utilizing the sitting position have been shown to improve success rates. The use of a novel LP cradle to standardize seated positioning and obviate immobilization variability may reduce the likelihood of repeated attempts and traumatic LPs. Objectives To determine the first-pass success rate of LPs using the cradle compared to a control group in lateral decubitus. First-pass success is defined as obtention of cerebrospinal fluid with red blood cell (RBC) count <10,000 cells/µL on first attempt. Secondary objectives were to compare overall LP success rate for >1 attempt, and traumatic LP rate (>400 RBCs/µL) with and without the cradle. Design/Methods This was a single center retrospective cohort study from August 2020 to October 2024. Term and corrected preterm infants aged ≥ 37 weeks and ≤ 3 months, presenting to the emergency, and requiring an LP were identified through an EPIC report. Unstable infants, those requiring opening pressure and charts lacking an LP procedure note were excluded. Cases using the SMöLTAP LP cradle were identified first, and concurrent controls were randomly selected. A sample size of 71 per group was calculated to detect a 20% absolute increase in first-pass success rate with 80% power and a 5% two-sided alpha. All outcomes were analyzed using chi-squared tests. Logistic regression was used to control for age, weight, prematurity, acuity, physician experience, use of local anesthetics, and day/night shift. Results 142 infants (71 per group) were included. Mean age was 26 days (SD 20), and 57% were male. Overall, first-pass success rate in our sample was 74/142 (52%). Use of the cradle resulted in a higher first-pass success rate χ2 (1, 142) = 7.22, p=0.007, and fewer traumatic taps χ2 (1, 118) = 8.17, p=0.005. There was no difference in overall success rate, 57/71 (80%) compared to 50/71 (70%), p=0.173. Cradle use remained significantly associated with first-pass success after adjusting for age, weight, prematurity, acuity, physician experience, use of local anesthetic, or day/night shift (OR 2.23, 95% CI 1.06-4.70, p=0.036). Conclusion An LP cradle is a promising tool for improving first-pass success of LPs and decreasing traumatic tap rates. A larger prospective study is warranted to evaluate its effectiveness and potential impact on clinical practice.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,004 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».