Ultrasound-Assisted Lumbar Puncture in Children: A Meta-Analysis

Abstract

CONTEXT Success rates of lumbar puncture are rather low in children. Ultrasound guidance has been suggested to increase success rate.

OBJECTIVE To systematically compare lumbar puncture success with and without ultrasound in children.

DATA SOURCES PubMed, Scopus, and Web of Science databases were searched in January 2023.

STUDY SELECTION Randomized controlled trials including children (aged <18 years) and comparing ultrasound-assisted lumbar puncture to palpation-marked lumbar puncture were included.

DATA EXTRACTION One author extracted, and the other author validated data.

RESULTS Seven studies were included. First puncture success rate was 71.7% (190 of 265) in the ultrasound group and 58.9% (155 of 263) in the palpation group (risk ratio [RR], 1.22; (confidence interval [CI], 1.00–1.50; 5 studies). First puncture success rate with ultrasound was higher in infants (RR, 1.41; CI, 1.10–1.80; 3 studies), but not in older children (RR, 1.07; CI, 0.98–1.17; 2 studies). Overall success rate was 89.3% (276 of 309) in the ultrasound group and 80.3% (248 of 309) in the palpation group (RR, 1.11; CI 0.95–1.30; 7 studies).

LIMITATIONS Evidence quality was rated low because of risk of bias (3 studies high risk of bias) and imprecision.

CONCLUSIONS Ultrasound use may improve first puncture success rate in infants but not in older children. We did not find evidence of difference in overall success rate. Better quality evidence is needed before implementing ultrasound guidance in practice.