Derek R. Spindler, MD; Sadie J. Skarloken, MD; Sarah A. Webber, MD; Daniel Sklansky, MD
Background: It is important for physicians to perform successful lumbar puncture (LP) in order to obtain cerebral spinal fluid (CSF) in the workup of febrile neonates. Recent studies indicate that opportunities for residents to perform LP are decreasing and a corresponding decline in resident success with LP1. Furthermore, simulation practice may not improve success rates. We sought to determine if resident LP success rate is indeed lower than that of attending physicians. We hypothesize that because attending physicians have more experience and likely trained in an era with more LP opportunities, their success rates are higher than recent residents. To our knowledge no prior studies have compared attending and resident LP success rates.
Methods: Charts of infants < 30 days old admitted from 2001 through 2015 were identified in our electronic database using institutional coding for lumbar puncture, CSF lab studies, and blood cultures. Blood culture was queried to capture children with failed LPs who subsequently did not have LP billing or CSF results to trigger identification for the study. We recorded success in obtaining CSF in the first LP session, number of needle insertions required per session, and training status of the procedure provider. Success was defined by any lab report of CSF. Success rates based on training status were compared using a Chi-square test.
Results: We identified 184 patients undergoing LP during the study period, with a first-session failure rate of 27.2%. Residents were successful 70.1% of sessions vs. 87.1% for attendings (Chi-square P-value = 0.050). For LP sessions in which the number of spinal needle insertions was reported, there were a mean of 2.14 insertions with median of 2 insertions per session.
Conclusions: Over the study period, resident physicians were less likely than attendings to have a successful LP attempt. Further analysis of success rate trends over time, and specific patient and provider characteristics may reveal reasons for lower resident success other than lack of experience. This data may provide insight into future interventions to increase resident LP success rate.