Reducing General Anesthesia for Lumbar Punctures in Pediatric Patients With Leukemia and Lymphoma, a Quality Improvement Project
Bibliographic record
Abstract
PURPOSE: Curative therapy for most children with leukemia and lymphoma includes multiple lumbar punctures (LPs) for the administration of intrathecal chemotherapy, commonly facilitated with deep sedation or general anesthesia (GA). There is ongoing concern about the potential for neurocognitive deficits induced by GA in the developing brain. The objective of this quality improvement (QI) project was to implement and evaluate a process whereby children received the level of sedation they need for their LPs and not GA by default. METHODS: We included children at our center aged 5-18 years who required LPs as part of leukemia and lymphoma therapy. Eligible patients were approached by the primary oncology team, provided with educational materials, and offered the opportunity to participate by selecting their preferred level of sedation. Nonpharmacological anxiety reduction strategies were maximized, and pharmacological interventions were minimized, but not withheld, and customized to each patient's needs. RESULTS: The baseline rate of LPs without GA (pre-intervention) was 3%. During the QI project, LPs without GA increased to 11% (p = 0.049). There was a significant increase in patients aged 5-9 completing LPs without anesthesia (0% to 6%, p = 0.029). The majority of patients completed LPs with IV midazolam (63%). Most patients (80%) had more than one LP without GA. CONCLUSION: Our QI initiative was successful in improving the rates of LPs completed without GA. Future efforts will be aimed to increase GA-free LP rates and explore the applicability of these methods to other procedures requiring anesthesia in pediatric care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.038 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".