Purpose Lumbar puncture (LP) is a routine procedure performed on infants < 90 days for diagnostic evaluation of suspected meningitis or seizures. Occasionally the initial attempt fails to yield a sample of cerebral spinal fluid for diagnostic testing, leading to management dilemmas with incomplete information. At Primary Children's Medical Center (PCMC), patients who have a failed LP are frequently referred for imaging assistance with either ultrasound or fluoroscopy success of LP, length of stay (LOS), and cost of hospitalization.
Methods To identify patients less than 90 days of age who were referred to interventional radiology for LP after at least one failed previous attempt, PCMC's radiology database was queried, from August 2002 through July 2005. Patient medical records were subsequently reviewed. PCMC's administrative database was queried for the same time period to establish a control group of all hospitalized infants < 90 days with a successful LP. Wilcoxon rank sum tests were performed to compare LOS and cost of hospitalization for patients who had a successful LP with radiological intervention, compared to the control group. Median and interquartile ranges (IQR) are presented. All statistical analyses were performed using SAS v 9.12 (Carey, NC).
Results 1,547 patients had a successful LP performed during hospitalization, from 08/2002-07/2005. 62 patients (4%) were evaluated for imaging-assisted LP after a failed previous attempt. The ultimate success rate in radiology was 95.2%. 7 patients underwent ultrasound of the thecal sac with no LP attempt secondary to identification of limited fluid below the conus; re-evaluation with ultrasound resulted in success of LP in all 7 patients. Median LOS for the imaging assisted group was longer compared to the control group [70 (IQR 54-117) hrs vs 42 (IQR 57-92) hrs p = .003]. Median cost of hospitalization for the imaging=assisted group was higher compared to the control group [$4,799 (IQR $3,643-$7,271) vs $3,731 ($2,843-$6,364), p = .002].
Conclusions Imaging assistance with either ultrasound or fluoroscopy yields a high success rate for LP in patients that had a previously failed attempt. However, LOS and cost of hospitalization are significantly higher. System-based analysis identifying the contributors, both clinical and technological, to LOS and cost will facilitate standardized intervention strategies to more efficiently manage patients < 90 days with a previously failed LP.
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