Abstract
The purpose of the study was to evaluate patient outcomes, including success rates, factors associated with unsuccessful procedures and frequency of post-lumbar puncture headaches (PLPH), at a dedicated academic outpatient lumbar puncture (LP) clinic. All patients referred to our LP clinic between June 1, 2014 and May 31, 2015 were included in this consecutive observational series. We collected information about patient characteristics, operational parameters of the procedure, and complications. We also recorded rates of participation in biomedical research involving use of cerebrospinal fluid. Univariate analysis used Student’s t test and Fisher’s exact test. Logistic regression was used to determine independent risk factors associated with unsuccessful LP and PLPH. The mean age of patients referred to our LP clinic was 46 ± 17 years. Of the 307 referrals, 281 patients (92%) started the procedure, with successful acquisition of CSF in 267 (95%). Factors contributing to unsuccessful procedures included higher body mass index [odds ratio (OR) 1.8], older age (OR 1.9), and female sex (OR 10.3). The rate of PLPH was 5.7%. Younger age (OR 0.5), female sex (OR 6.9), high mean arterial pressure (OR 2.2), and a traumatic LP (OR 10.0) were identified as risk factors for PLPH. Notably, 202 patients (72%) consented to biomedical research. A standardized approach to outpatient LP demonstrates high procedural success rate, low PLPH rate, and high participation in biomedical research. Awareness of a group of patients at higher risk for complications including procedure failure or PLPH provides guidance for decision-making regarding referral to the outpatient LP clinic.
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Acknowledgements
We thank the residents, staff, and patients of the Johns Hopkins LP clinic. We are grateful for the support provided by The Bart McLean Fund for Neuroimmunology Research and Johns Hopkins Project RESTORE.
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PB: data collection, data analysis and interpretation, and writing; DRB: data interpretation and writing; JFB: statistical analysis; CAP: data interpretation and manuscript review; AJ: data collection and data interpretation; RF: data interpretation and writing; MNB: study design, data collection, data interpretation, writing, and project oversight.
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Dr. Paula Barreras, Dr. David R. Benavides, Mr. Jorge F. Barreras, Dr. Carlos A. Pardo, Ms. Ami Jani, Dr. Roland Faigle, and Dr. Mona N. Bahouth have nothing to disclose.
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This study was approved by the Johns Hopkins Institutional Review Board and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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Barreras, P., Benavides, D.R., Barreras, J.F. et al. A dedicated lumbar puncture clinic: performance and short-term patient outcomes. J Neurol 264, 2075–2080 (2017). https://doi.org/10.1007/s00415-017-8597-6
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DOI: https://doi.org/10.1007/s00415-017-8597-6