Ultrasound-Assisted Lumbar Punctures in Children: An Updated Systematic Review With Meta-Analysis

CONTEXT Lumbar puncture (LP) is a common procedure in children, but the rates of unsuccessful and traumatic LPs remain high. Point-of-care ultrasound (POCUS) has been proposed as a tool for improvement.OBJECTIVES Our aim was to systematically review current evidence on the usefulness of POCUS assisted LP in children.DATA SOURCES PubMed, Embase, and the CENTRAL were searched up to November 2022.STUDY SELECTION We searched for randomized control trials assessing the effectiveness of POCUS assisted LP in children.DATA EXTRACTION Data were extracted by 2 reviewers independently.RESULTS Seven randomized control trials involving 618 participants were included. Overall, the first attempt POCUS assisted LP was successful in 72% compared with 59.6% in the standard group, regardless of the definition used. The calculated risk difference was 13.0% (95% confidence interval [CI]: 3% to 23%) I2:53%, odds ratio: 2.00 (95% CI: 1.13 to 3.53), I2: 45% and risk ratio:1.21 (95% CI: 1.01 to 1.44) I2:64%. Additionally, fewer traumatic LPs occurred in the US-assisted group, with a risk difference of -12% (95% CI: -0.22 to -0.03), odds ratio: 0.45 (95% CI: 0.26 to 0.78) and risk ratio: 0.53 (95% CI: 0.35 to 0.79). POCUS did not extend the duration of LP procedure with mean difference: -1.11 (95% CI: -2.88 to 0.66).CONCLUSIONS POCUS improved the first attempt success rate and reduced the incidence of traumatic LPs compared with standard LP procedure in children. Therefore, if it is available, POCUS should be used routinely before every LP, especially when performed by less experienced physicians.