The evaluation of the indications, effectiveness and results of lumbar punctures applied in Dokuz Eylul University children's Hospital

Background and Aim: Lumbar puncture (LP) is an invasive procedure that is frequently applied for diagnosis and treatment in pediatrics. The aim of this study was to evaluate the indications, efficacy and complications of lumbar punctures performed in the Department of Pediatrics, Dokuz Eylul University Faculty of Medicine. Materials and Methods: Physicians who applied LP to the inpatients of Dokuz Eylul University Faculty of Medicine, Department of Pediatrics between 01.08.2016 - 01.02.2019 were asked to fill out the questionnaires. Dependent variables were defined as successful and failed lumbar punctures. The aim of this study was to investigate the role of independent variables such as sex, age, chronic disease, hematology oncology patient, obesity, neurological examination findings, planned LP procedure, physician's seniority, application of sedation, success of sedation, physician who is applying sedation, application of local anesthesia, the position given to the patient, type of LP needles, the removal of the stylet after the skin-to-skin pass, the stylet staying until arrival, the feeling of entering the subarachnoid space and the number of recurrent LP to LP success. Findings: A total of 786 patients underwent LP and 480 (61.1%) questionnaires were distributed, of which 142 (29.6%) were completed and returned. As the survey data were inconsistent and / or incomplete, 12 out of 142 survey datas were excluded from the study. Of the 130 cases included in the study, 73 (56.2%) were male and 57 (43.8%) were female. Their ages ranged from 0.1 months to 217 months, with a median of 60.1 months. LP indications were intratechal treatment (n=51, %39,2), central nervous system infection (n=44, %38,8), sepsis (n=18, %13,8), pseudotumor cerebri (n=7, %5,4), investigation of malignancy involvement (n=5, %1,5), demyelinating disease (n=2, %1,5), metabolic disease (n=2, %1,5) and control (n=1, %0,8). Of the 130 LP attempts, 63 (48.5%) were successful LP and 67 (51.5%) failed. The age of patients with failed LP procedures (mean 63,041 months) were younger than successful LP procedures (mean 93,478 months) (p=0,018). The second year assistants were more successful than the assistants in other years (p=0,01). Of the 103 patients who underwent sedation, 56 (54.4%) had successful LP, whereas 7 (25.9%) of the 27 patients who did not undergo sedation were successful (p=0.008). The failure of sedation increased 3.4 times the probability of failure. Of the 110 cases in which the stile was stuck until arrival, 50 (64.1%) were successful and 5 (15.6%) of the 32 cases which didn't stuck until arrival were successful (p=0,0001). The removal of the stylet increases the risk of failure by 9.64 times. While 61 (59.2%) of the 103 procedures that the physician who performed LP felt entering the subarachnoid space were successful, only 2 (7.4%) of 27 procedures were successful when physician didn't feel entering the subarachnoid space. Unfeeling the subarachnoid interval increased the failure rate by 18,155 times. LP position, previously known disease, hematology-oncology patient, neurological examination abnormality, body mass index and needle did not affect LP success (p>0,05). Result: The success rate of LP was found to be 48.5% in our study. The age of the patient, sedation, the stylet remaining stuck until arrival and the feel of entering the subarachnoid space were important factors affecting LP success. The addition of courses related to the LP procedure in assistant education, the number of performed LP of each assistant, the creation of checklists and protocols for the LP process can increase the success of the LP. Key words: Lumbar puncture, pediatrics, success