Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room

Abstract

Purpose: Lumbar puncture (LP) is a medical procedure in which a cerebrospinal fluid sample is takenfor biochemical, microbiological and cytological examination. The aim of our study was to compare theultrasonography (USG) method to the palpation method in determining the location of LP.Methods: 203 patients were included in the study. In the study, specifying location manually or with USG wasperformed by the same emergency medicine resident with USG certificate who completed his 4th year. LPpoints were determined and marked firstly by ultrasound and then the manual method while the patients werein the left and right lateral decubitus and sitting positions.Results: The USG method was found to be significantly more successful than the manual method in determiningthe LP location (p=0.012). The USG method was found to be significantly more successful in determining theLP site than the manual method, especially when the LP site was identified in the sitting position (p=0.031).In other positions, no difference was observed between the two groups (Right p=1, Left p=0.500). Body MassIndex (BMI) affects success during site location with USG (p=0.0001). Likewise, BMI affected the success inidentifying the LP site by the manual method (p=0.0001). The USG method was found to be significantly moresuccessful than the manual method in determining the LP site in patients with BMI>25 (p=0.012).Conclusion: During the detection of LP location by palpation or USG, as the BMI increased, the duration of thedetermination of location increased significantly, too. LP site can be identified by the USG in patients whose LPsite cannot be specified by palpation. In addition, the USG is more successful in obese individuals in terms oflocating the LP site.