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E2083. Lumbar Punctures at Children’s Hospitals: Trends, Outcomes, and Innovations
Authors
  1. Kristen Crumley; University of Texas Southwestern Medical Center
  2. Desi Schiess; University of Texas Southwestern Medical Center
  3. Sreeja Sanampudi; University of Texas Southwestern Medical Center
  4. Cory Pfeifer; University of Texas Southwestern Medical Center
Objective:
The purpose of this study is to assess the growing trend of image-guided lumbar punctures in children and to evaluate factors affecting successful cerebrospinal fluid recovery.

Materials and Methods:
The total number of lumbar puncture requests at a large children’s hospital was documented from January 2015 through June 2018. Images and reports were reviewed for all image-guided lumbar punctures performed over 365 consecutive days. The ordering service, patient’s age, reason for exam, patient position, vertebral level, needle gauge, performing radiologist, and involvement of a resident or fellow were recorded for each procedure. Success rates were assessed for general pediatric radiologists and for pediatric interventional radiologists.

Results:
Image-guided lumbar punctures performed in the radiology department increased by 64% from 2015 to 2018, with up to 45-50 outpatient requests per week. Most ordering providers were general pediatricians (38%), neurologists (25%), and hospitalists (16%), with the greatest increase coming from hospitalists and general pediatricians. The most common indication was pseudotumor cerebri (61%). The success rate was 93% among general pediatric radiologists, with 80% of them exhibiting a 100% success rate. Two pediatric radiologists with 75% success rates did not receive dedicated lumbar puncture training during fellowship. Patient age, position, vertebral level, needle gauge, and trainee involvement were not statistically significant discriminators of success. After transferring lumbar punctures to the dedicated pediatric interventional radiology service using bi-plane fluoroscopy, the success rate improved to 100%.

Conclusion:
This analysis demonstrates a marked increase in requests for pediatric image-guided lumbar punctures, most often for pseudotumor cerebri, raising concern that increasing childhood obesity may be a contributing factor. Pediatric radiologists are capable of high success rates with sufficient training. Thus, pediatric radiology training programs should adapt to reflect the need for this valuable skill. Until then, children’s hospitals in which pediatric radiologists perform lumbar punctures should consider directing these requests to a dedicated pediatric interventional radiology service using bi-plane fluoroscopy.