Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic

Edward R. Hammond, Zhuangjun Wang, Nihal Bhulani, Justin Charles McArthur, Michael Levy

Research output: Contribution to journalArticle

Abstract

Objective: Post-lumbar puncture headaches (PLPHs) are a common complication of diagnostic lumbar punctures (LPs) caused by a persistent leak of spinal fluid from the dural puncture site. We conducted a prospective study to determine risk factors associated with PLPHs in the neurology outpatient setting. Methods: Clinical information from all diagnostic LPs performed at the Johns Hopkins Lumbar Puncture Clinic between September 2008 and June 2009 was reviewed. As standard of care, each patient was contacted by telephone by the attending physician within 2-5 days of having an LP to ascertain health status and the presence of PLPH. We performed multiple logistic regression analysis to evaluate the association between PLPH and needle type (traditional Quincke cutting needle 20 and 22 gauge, 20Q and 22Q, and Sprotte non-traumatic gauge 22 needle, 22S) adjusting for important variables such as traumatic LPs, number of attempts, positioning and volume of CSF drawn. Results: The prevalence of PLPH was 32% with the popular gauge 20Q and 22Q needles compared to 19% with the 22S non-traumatic needle. Compared to the 20Q needle, the non-traumatic 22S needle was associated with 69% decreased odds of PLPH (adjusted OR: 0.31, 95% CI 0.12-0.82). In subset analysis, the odds of PLPH increased 4-fold when the 22Q needle was used compared to the 22S needle (adjusted OR = 3.99, 95% CI 1.32-12.0). Conclusions: Our outpatient findings support the American Academy of Neurology recommendations to use smaller non-traumatic needles to reduce the risk of PLPH.

Original languageEnglish (US)
Pages (from-to)24-28
Number of pages5
JournalJournal of the Neurological Sciences
Volume306
Issue number1-2
DOIs
StatePublished - Jul 15 2011

Fingerprint

Post-Dural Puncture Headache
Neurology
Ambulatory Care Facilities
Needles
Spinal Puncture
Outpatients
Standard of Care
Punctures
Telephone
Health Status
Logistic Models
Regression Analysis

Keywords

  • Lumbar puncture
  • Needle type
  • Neurology outpatient clinic
  • Post-lumbar puncture headache

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic. / Hammond, Edward R.; Wang, Zhuangjun; Bhulani, Nihal; McArthur, Justin Charles; Levy, Michael.

In: Journal of the Neurological Sciences, Vol. 306, No. 1-2, 15.07.2011, p. 24-28.

Research output: Contribution to journalArticle

Hammond, Edward R. ; Wang, Zhuangjun ; Bhulani, Nihal ; McArthur, Justin Charles ; Levy, Michael. / Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic. In: Journal of the Neurological Sciences. 2011 ; Vol. 306, No. 1-2. pp. 24-28.
@article{7b72a44f149f4181bc1caec96f2d0d6f,
title = "Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic",
abstract = "Objective: Post-lumbar puncture headaches (PLPHs) are a common complication of diagnostic lumbar punctures (LPs) caused by a persistent leak of spinal fluid from the dural puncture site. We conducted a prospective study to determine risk factors associated with PLPHs in the neurology outpatient setting. Methods: Clinical information from all diagnostic LPs performed at the Johns Hopkins Lumbar Puncture Clinic between September 2008 and June 2009 was reviewed. As standard of care, each patient was contacted by telephone by the attending physician within 2-5 days of having an LP to ascertain health status and the presence of PLPH. We performed multiple logistic regression analysis to evaluate the association between PLPH and needle type (traditional Quincke cutting needle 20 and 22 gauge, 20Q and 22Q, and Sprotte non-traumatic gauge 22 needle, 22S) adjusting for important variables such as traumatic LPs, number of attempts, positioning and volume of CSF drawn. Results: The prevalence of PLPH was 32{\%} with the popular gauge 20Q and 22Q needles compared to 19{\%} with the 22S non-traumatic needle. Compared to the 20Q needle, the non-traumatic 22S needle was associated with 69{\%} decreased odds of PLPH (adjusted OR: 0.31, 95{\%} CI 0.12-0.82). In subset analysis, the odds of PLPH increased 4-fold when the 22Q needle was used compared to the 22S needle (adjusted OR = 3.99, 95{\%} CI 1.32-12.0). Conclusions: Our outpatient findings support the American Academy of Neurology recommendations to use smaller non-traumatic needles to reduce the risk of PLPH.",
keywords = "Lumbar puncture, Needle type, Neurology outpatient clinic, Post-lumbar puncture headache",
author = "Hammond, {Edward R.} and Zhuangjun Wang and Nihal Bhulani and McArthur, {Justin Charles} and Michael Levy",
year = "2011",
month = "7",
day = "15",
doi = "10.1016/j.jns.2011.04.004",
language = "English (US)",
volume = "306",
pages = "24--28",
journal = "Journal of the Neurological Sciences",
issn = "0022-510X",
publisher = "Elsevier",
number = "1-2",

}

TY - JOUR

T1 - Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic

AU - Hammond, Edward R.

AU - Wang, Zhuangjun

AU - Bhulani, Nihal

AU - McArthur, Justin Charles

AU - Levy, Michael

PY - 2011/7/15

Y1 - 2011/7/15

N2 - Objective: Post-lumbar puncture headaches (PLPHs) are a common complication of diagnostic lumbar punctures (LPs) caused by a persistent leak of spinal fluid from the dural puncture site. We conducted a prospective study to determine risk factors associated with PLPHs in the neurology outpatient setting. Methods: Clinical information from all diagnostic LPs performed at the Johns Hopkins Lumbar Puncture Clinic between September 2008 and June 2009 was reviewed. As standard of care, each patient was contacted by telephone by the attending physician within 2-5 days of having an LP to ascertain health status and the presence of PLPH. We performed multiple logistic regression analysis to evaluate the association between PLPH and needle type (traditional Quincke cutting needle 20 and 22 gauge, 20Q and 22Q, and Sprotte non-traumatic gauge 22 needle, 22S) adjusting for important variables such as traumatic LPs, number of attempts, positioning and volume of CSF drawn. Results: The prevalence of PLPH was 32% with the popular gauge 20Q and 22Q needles compared to 19% with the 22S non-traumatic needle. Compared to the 20Q needle, the non-traumatic 22S needle was associated with 69% decreased odds of PLPH (adjusted OR: 0.31, 95% CI 0.12-0.82). In subset analysis, the odds of PLPH increased 4-fold when the 22Q needle was used compared to the 22S needle (adjusted OR = 3.99, 95% CI 1.32-12.0). Conclusions: Our outpatient findings support the American Academy of Neurology recommendations to use smaller non-traumatic needles to reduce the risk of PLPH.

AB - Objective: Post-lumbar puncture headaches (PLPHs) are a common complication of diagnostic lumbar punctures (LPs) caused by a persistent leak of spinal fluid from the dural puncture site. We conducted a prospective study to determine risk factors associated with PLPHs in the neurology outpatient setting. Methods: Clinical information from all diagnostic LPs performed at the Johns Hopkins Lumbar Puncture Clinic between September 2008 and June 2009 was reviewed. As standard of care, each patient was contacted by telephone by the attending physician within 2-5 days of having an LP to ascertain health status and the presence of PLPH. We performed multiple logistic regression analysis to evaluate the association between PLPH and needle type (traditional Quincke cutting needle 20 and 22 gauge, 20Q and 22Q, and Sprotte non-traumatic gauge 22 needle, 22S) adjusting for important variables such as traumatic LPs, number of attempts, positioning and volume of CSF drawn. Results: The prevalence of PLPH was 32% with the popular gauge 20Q and 22Q needles compared to 19% with the 22S non-traumatic needle. Compared to the 20Q needle, the non-traumatic 22S needle was associated with 69% decreased odds of PLPH (adjusted OR: 0.31, 95% CI 0.12-0.82). In subset analysis, the odds of PLPH increased 4-fold when the 22Q needle was used compared to the 22S needle (adjusted OR = 3.99, 95% CI 1.32-12.0). Conclusions: Our outpatient findings support the American Academy of Neurology recommendations to use smaller non-traumatic needles to reduce the risk of PLPH.

KW - Lumbar puncture

KW - Needle type

KW - Neurology outpatient clinic

KW - Post-lumbar puncture headache

UR - http://www.scopus.com/inward/record.url?scp=79958765244&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79958765244&partnerID=8YFLogxK

U2 - 10.1016/j.jns.2011.04.004

DO - 10.1016/j.jns.2011.04.004

M3 - Article

VL - 306

SP - 24

EP - 28

JO - Journal of the Neurological Sciences

JF - Journal of the Neurological Sciences

SN - 0022-510X

IS - 1-2

ER -