The Effect of Bedside Ultrasound Assistance on the Proportion of Successful Infant Spinal Taps

NCT ID: NCT02133066

Last Updated: 2017-08-31

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

128 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-05-31

Study Completion Date

2017-01-31

Brief Summary

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The reported rate of unsuccessful spinal taps in children, especially young infants, is high. Our hypothesis is that ultrasound assistance can improve the success rate of spinal taps.

Detailed Description

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The reported rate of unsuccessful spinal taps in children is high. At the Children's Hospital of Philadelphia (CHOP), quality improvement data demonstrates a failure rate of \~40-50%. Research has shown that bedside ultrasound can improve visualization and improve the success rate of spinal taps. Increasing the proportion of successful spinal taps in the emergency department could significantly reduce the rate of unnecessary hospitalizations, additional interventional procedures and antibiotic use. Our objective is to determine if bedside ultrasound-assisted site marking will increase the proportion of first attempt successful spinal taps. This will be a prospective, randomized controlled study that will take place over the course of 18 months with the goal to recruit a sample of approximately 128 patients. We will recruit subjects from the CHOP Emergency Department. The patients will be randomized into an ultrasound-assisted group versus a non-ultrasound-assisted group. Our hypothesis is that bedside ultrasound-assisted site marking will increase the number of successful spinal taps.

Conditions

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Traumatic Lumbar Puncture

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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US-Assisted site marking for Lumbar Punctures (LP)

Mindray M7 Ultrasound marking

Group Type ACTIVE_COMPARATOR

Bedside Ultrasound-Assisted Site Marking

Intervention Type PROCEDURE

Patient will receive a bedside ultrasound-assisted site marking of the most appropriate site for lumbar puncture prior to the clinician completing the spinal tap using Mindray M7 Ultrasound.

Mindray M7 Ultrasound

Intervention Type DEVICE

Patient will receive a bedside ultrasound exam of the most appropriate site for lumbar puncture prior to the clinician completing the spinal tap

Routine lumbar puncture

These patients will receive no ultrasound-assisted site marking prior to lumbar puncture; The patients will simply have a "standard-of-care" spinal tap performed by the clinician

Group Type PLACEBO_COMPARATOR

Routine lumbar puncture

Intervention Type PROCEDURE

Lumbar puncture will be performed per routine standard of care

Interventions

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Bedside Ultrasound-Assisted Site Marking

Patient will receive a bedside ultrasound-assisted site marking of the most appropriate site for lumbar puncture prior to the clinician completing the spinal tap using Mindray M7 Ultrasound.

Intervention Type PROCEDURE

Mindray M7 Ultrasound

Patient will receive a bedside ultrasound exam of the most appropriate site for lumbar puncture prior to the clinician completing the spinal tap

Intervention Type DEVICE

Routine lumbar puncture

Lumbar puncture will be performed per routine standard of care

Intervention Type PROCEDURE

Other Intervention Names

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Mindray M7 Ultrasound M7/M7T Diagnostic Ultrasound

Eligibility Criteria

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Inclusion Criteria

* Less than or equal to six months of age
* Plan for diagnostic or therapeutic lumbar puncture as per front line clinician
* Availability of a study sonographer to perform bedside ultrasound

Exclusion Criteria

* Known spinal cord abnormality (e.g., tethered cord, spina bifida)
Maximum Eligible Age

6 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Children's Hospital of Philadelphia

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Aaron E Chen, MD

Role: PRINCIPAL_INVESTIGATOR

CHOP

Locations

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Children's Hospital of Philadelphia Emergency Department

Philadelphia, Pennsylvania, United States

Site Status

Countries

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United States

References

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Abo A, Chen L, Johnston P, Santucci K. Positioning for lumbar puncture in children evaluated by bedside ultrasound. Pediatrics. 2010 May;125(5):e1149-53. doi: 10.1542/peds.2009-0646. Epub 2010 Apr 19.

Reference Type BACKGROUND
PMID: 20403933 (View on PubMed)

Baxter AL, Fisher RG, Burke BL, Goldblatt SS, Isaacman DJ, Lawson ML. Local anesthetic and stylet styles: factors associated with resident lumbar puncture success. Pediatrics. 2006 Mar;117(3):876-81. doi: 10.1542/peds.2005-0519.

Reference Type BACKGROUND
PMID: 16510670 (View on PubMed)

Bruccoleri RE, Chen L. Needle-entry angle for lumbar puncture in children as determined by using ultrasonography. Pediatrics. 2011 Apr;127(4):e921-6. doi: 10.1542/peds.2010-2511. Epub 2011 Mar 28.

Reference Type BACKGROUND
PMID: 21444601 (View on PubMed)

Coley BD, Murakami JW, Koch BL, Shiels WE 2nd, Bates G, Hogan M. Diagnostic and interventional ultrasound of the pediatric spine. Pediatr Radiol. 2001 Nov;31(11):775-85. doi: 10.1007/s002470100535.

Reference Type BACKGROUND
PMID: 11692234 (View on PubMed)

Dietrich AM, Coley BD. Bedside pediatric emergency evaluation through ultrasonography. Pediatr Radiol. 2008 Nov;38 Suppl 4:S679-84. doi: 10.1007/s00247-008-0890-1. Epub 2008 Sep 23.

Reference Type BACKGROUND
PMID: 18810417 (View on PubMed)

Ferre RM, Sweeney TW. Emergency physicians can easily obtain ultrasound images of anatomical landmarks relevant to lumbar puncture. Am J Emerg Med. 2007 Mar;25(3):291-6. doi: 10.1016/j.ajem.2006.08.013.

Reference Type BACKGROUND
PMID: 17349903 (View on PubMed)

Furness G, Reilly MP, Kuchi S. An evaluation of ultrasound imaging for identification of lumbar intervertebral level. Anaesthesia. 2002 Mar;57(3):277-80. doi: 10.1046/j.1365-2044.2002.2403_4.x.

Reference Type BACKGROUND
PMID: 11892638 (View on PubMed)

Lam WW, Ai V, Wong V, Lui WM, Chan FL, Leong L. Ultrasound measurement of lumbosacral spine in children. Pediatr Neurol. 2004 Feb;30(2):115-21. doi: 10.1016/j.pediatrneurol.2003.07.002.

Reference Type BACKGROUND
PMID: 14984904 (View on PubMed)

Nigrovic LE, Kuppermann N, Neuman MI. Risk factors for traumatic or unsuccessful lumbar punctures in children. Ann Emerg Med. 2007 Jun;49(6):762-71. doi: 10.1016/j.annemergmed.2006.10.018. Epub 2007 Feb 23.

Reference Type BACKGROUND
PMID: 17321005 (View on PubMed)

Nigrovic LE, Shah SS, Neuman MI. Correction of cerebrospinal fluid protein for the presence of red blood cells in children with a traumatic lumbar puncture. J Pediatr. 2011 Jul;159(1):158-9. doi: 10.1016/j.jpeds.2011.02.038. Epub 2011 Apr 14.

Reference Type BACKGROUND
PMID: 21492866 (View on PubMed)

Nomura JT, Leech SJ, Shenbagamurthi S, Sierzenski PR, O'Connor RE, Bollinger M, Humphrey M, Gukhool JA. A randomized controlled trial of ultrasound-assisted lumbar puncture. J Ultrasound Med. 2007 Oct;26(10):1341-8. doi: 10.7863/jum.2007.26.10.1341.

Reference Type BACKGROUND
PMID: 17901137 (View on PubMed)

Oncel S, Gunlemez A, Anik Y, Alvur M. Positioning of infants in the neonatal intensive care unit for lumbar puncture as determined by bedside ultrasonography. Arch Dis Child Fetal Neonatal Ed. 2013 Mar;98(2):F133-5. doi: 10.1136/archdischild-2011-301475. Epub 2012 Jun 9.

Reference Type BACKGROUND
PMID: 22684159 (View on PubMed)

Pappano D. "Traumatic tap" proportion in pediatric lumbar puncture. Pediatr Emerg Care. 2010 Jul;26(7):487-9. doi: 10.1097/PEC.0b013e3181e5bedd.

Reference Type BACKGROUND
PMID: 20577138 (View on PubMed)

Peterson MA, Abele J. Bedside ultrasound for difficult lumbar puncture. J Emerg Med. 2005 Feb;28(2):197-200. doi: 10.1016/j.jemermed.2004.09.008.

Reference Type BACKGROUND
PMID: 15707816 (View on PubMed)

Pinheiro JM, Furdon S, Ochoa LF. Role of local anesthesia during lumbar puncture in neonates. Pediatrics. 1993 Feb;91(2):379-82.

Reference Type BACKGROUND
PMID: 8424014 (View on PubMed)

Schreiner RL, Kleiman MB. Incidence and effect of traumatic lumbar puncture in the neonate. Dev Med Child Neurol. 1979 Aug;21(4):483-7. doi: 10.1111/j.1469-8749.1979.tb01652.x.

Reference Type BACKGROUND
PMID: 520695 (View on PubMed)

Srinivasan L, Shah SS, Abbasi S, Padula MA, Harris MC. Traumatic lumbar punctures in infants hospitalized in the neonatal intensive care unit. Pediatr Infect Dis J. 2013 Oct;32(10):1150-2. doi: 10.1097/INF.0b013e31829862b7.

Reference Type BACKGROUND
PMID: 23624433 (View on PubMed)

Other Identifiers

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13-010667

Identifier Type: -

Identifier Source: org_study_id

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