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Editorial

Editorial Deems Empowering Neurologists and Neurology Trainees to Perform Lumbar Punctures at Bedside a Worthwhile Goal

Many medical specialties now require graduating doctors to be skilled in point-of-care ultrasound (POCUS) for diagnosing patients and performing procedures. POCUS is a portable, ultrasound device used when fast, accurate information is necessary to make fast, accurate medical decisions. The Accreditation Council for Graduate Medical Education lists this as an official milestone for graduation. Even though training is improving for its possible use in treating head, eye and nerve conditions, POCUS is only used moderately by neurologists dealing with some  neurological conditions.

Ultrasound-guidance for procedures, such as lumbar puncture, is one application of POCUS. Ultrasound assisted lumbar punctures (USLP) and ultrasound guidance for similar neuraxial procedures have been evaluated for safety and efficacy in other specialties. However, data supporting the use of this technique by neurologists and neurology trainees are limited.

In an editorial in the journal Neurology: Education, researchers from Boston University Chobanian & Avedisian School of Medicine believe implementation of USLP in neurology could benefit the subsection of patients with the most challenging anatomy and urgent need for diagnostic clarity.

“We know which competency-based educational tools can be leveraged to maximize the chances of successful implementation in neurology. Empowering neurologists and neurology trainees to perform lumbar punctures (LP) at bedside in the interest of swift diagnosis and treatment, for example in meningitis, where there is an established association between time to treatment and patient outcomes, is a worthwhile goal,” explains corresponding author Daniel Harrison, MD, assistant professor of neurology at the school.

In the editorial Harrison and his colleague review the study by Grubman et al., which evaluated the possible benefits of USLP in neurology, analyzing previous studies in other fields and describing future steps for more widespread adoption of the technique. “It is clear when studied in other specialties, USLP has resulted in increases in overall and first-pass success rates, with reductions in patient-reported pain scores and possible rates of complications,” says Harrison, who also is a neurointensivist at Boston Medical Center.

According to the researchers, the benefits of USLP may be even more pronounced in patients who are overweight or have difficulty anatomy. “Considering these data, perhaps patients who seem most likely to benefit (for example, those with the highest body mass indices [BMIs] or severe back disease) should always have LP performed with ultrasound assistance, regardless of the discipline of the specialist performing the procedure,” he adds.

The researchers believe controlled multicenter studies focusing on higher level outcomes such as trainee performance, patient outcomes and health care or implementation cost may be effective in showing the success of USLP in other specialties translate to neurology.

The editorial appears online in the journal Neurology Education.