GP117 Lumbar puncture performance and the paediatric patient, one hospital’s experience

Aim To evaluate the frequency, indications, success rate and clinical impact on the performance of lumbar punctures (LP) in a paediatric population attending a general hospital. Methods Utilising the Mayo University Hospital Microbiology database the number of CSF samples analysed was determined over a 1 year period. Failed LPs were determined using blood Polymerase Chain Reaction (PCR) testing as a surrogate marker of sepsis. Data abstracted included 1) age 2) indication for LP 3) physician performer 4) procedure quality 5) number of attempts 6) CSF analysis and 7) final diagnosis. The charts of those patients with blood PCR requested were reviewed to discern the indication for the test and an evaluation of why the LP procedure failed. Results The number of procedures where CSF was obtained was 18, the indications for LP were a) 5 newborns with suspected sepsis, b) 2 neonates from home with fever without focus, c) 8 infants (29–90 days) with fever without focus and irritability, d) 3 over 3 months of age; 1 with 3 afebrile seizures and 2 with fever and an unwell appearance. ? Registrars performed 94% of the procedures ? Only 1 SHO attempted a LP but had a failed attempt ? The numbers of LP with 1 attempt was 15 (83%), 2 attempts 3 (17%). The number of atraumatic CSF was 15 (83%). The final diagnoses on the CSFs were: 13 sterile cultures and 5 positive for viruses. Of the 7 children who had Blood PCR performed, 1 had LP attempted and failed after 2 trials in a child who later proved to have pneumococcal sepsis. Conclusion LP is performed in infants rather than children. Consequently, attaining competency in LP performance will elude many Basic Specialist Trainees on their general paediatric rotations. Teaching LP performance using simulation techniques is required. Although bacterial meningitis is rare nowadays, LP is still required to evaluate cases of suspected Serious Bacterial Infection especially if no focus is found after initial assessment.