COMPARISON OF LUMBAR PUNCTURE SUCCESS RATES IN SITTING AND LATERAL DECUBITUS POSITIONS AMONG CHILDREN AGED
Main Article Content
Keywords
lumbar puncture; sitting position; lateral decubitus; paediatrics; success rate
Abstract
Background: Lumbar puncture (LP) is a common and essential paediatric procedure. Patient positioning may influence first-attempt success and the likelihood of traumatic taps, but comparative evidence across paediatric age groups remains limited.
Objectives: To compare LP success rates between the sitting and lateral decubitus positions in children aged <12 years and to evaluate secondary outcomes including number of attempts, traumatic taps and post-procedure complications.
Methods: This randomized controlled trial was conducted over 18 months (July 2023–December 2024) in a tertiary care hospital. Eighty-eight children requiring LP were randomized to undergo the procedure in either the lateral decubitus position (n=44) or the sitting position (n=44). The primary outcome was successful LP, defined as obtaining an adequate, non-traumatic CSF sample on the first attempt. Categorical variables were compared using the chi-square test; p<0.05 was considered statistically significant.
Results: Successful LP was achieved in 34/44 (77.3%) in the sitting group compared with 28/44 (63.6%) in the lateral decubitus group (p=0.161). First-attempt completion was higher in the sitting group (86.4%) than in the lateral group (77.3%, p=0.269). Non-traumatic LPs occurred in 84.1% of sitting procedures versus 77.3% in lateral decubitus (p=0.418). Post-procedure headache was rare and similar in both groups (2.3% each) and 97.7% of children in each group remained clinically stable post-procedure. Age-stratified success favoured sitting in <1 month (73.7% vs 56.3%) and 6–12 years (87.5% vs 50.0%) categories.
Conclusion: In children under 12 years, the sitting position demonstrated consistently higher LP success rates with a comparable safety profile to lateral decubitus positioning, although differences were not statistically significant. Position choice should be individualised based on age, cooperation and clinical context.
References
2. Tumani H, Petereit HF, Gerritzen A, Gross CC, Huss A, Isenmann S, et al. S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version). Neurol Res Pract. 2020 Dec;2:1–28.
3. Patel PB, Anderson HE, Keenly LD, Vinson DR. Informed consent documentation for lumbar puncture in the emergency department. West J Emerg Med. 2014 Apr 15;15(3):318.
4. Wright BL, Lai JT, Sinclair AJ. Cerebrospinal fluid and lumbar puncture: a practical review. J Neurol. 2012 Aug;259:1530–45.
5. Bianchine JR, McConnell H. Cerebrospinal Fluid in Neurology and Psychiatry. Springer; 2013 Nov 11.
6. Moghtaderi A, Alavi-Naini R, Sanatinia S. Lumbar puncture: techniques, complications and CSF analyses. In: Emergency Medicine—An International Perspective. InTech; 2012 Mar 16. p. 43–8.
7. Portuguese AJ, Rothberg A, Gorgone M, Strawderman M, Jacob C. Safety of bedside lumbar puncture in adult patients with thrombocytopenia. Ann Hematol. 2020 Aug;99:1755–62.
8. Cauley KA. Fluoroscopically guided lumbar puncture. AJR Am J Roentgenol. 2015 Oct;205(4):W442–50.
9. Kishawi S, Janko M, Kashyap VS, Carman T. Pre-procedural risk assessment and optimization. In: Endovascular Tools and Techniques Made Easy. CRC Press; 2020 Nov 30. p. 9–16.
10. Schulga P, Grattan R, Napier C, Babiker MO. How to use… lumbar puncture in children. Arch Dis Child Educ Pract Ed. 2015 Oct 1;100(5):264–71.
11. Vagnoli L, Caprilli S, Messeri A. Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: what could be the most promising option? Pediatr Anesth. 2010 Oct;20(10):937–43.
12. Goldman RD. Analgesia for lumbar puncture in infants and children. Can Fam Physician [Internet]. 2019 Mar 1 [cited 2025 Mar 29];65(3):192. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6515948/
13. Kamimura Y, Nagai A, Nakanishi T, Tsuji T, Tanaka M, Sobue K. Intercristal line determined by palpation in parturients in the sitting and the lateral decubitus positions: a prospective observational study. J Anesth [Internet]. 2022 Apr 1 [cited 2025 Mar 23];36(2):270–5. Available from: https://link.springer.com/article/10.1007/s00540-022-03045-8
14. Martin-Du Pan RC, Benoit R, Girardier L. The role of body position and gravity in the symptoms and treatment of various medical diseases. Swiss Med Wkly [Internet]. 2004 Sep 18;134(37–38):543–51. Available from: https://pubmed.ncbi.nlm.nih.gov/15551157/
15. Ellenby MS, Tegtmeyer K, Lai S, Braner DAV. Lumbar puncture [Internet]. 2006. Available from: www.nejm.org
16. Kuitunen I, Renko M. Lumbar puncture position in infants—a systematic review and meta-analysis. Eur J Pediatr [Internet]. 2023 Oct 1 [cited 2025 Mar 23];182(10):4573–81. Available from: https://pubmed.ncbi.nlm.nih.gov/37540241/
17. Sievänen H, Kari J, Huurre A, Palmu S. A previous champagne tap reduces the probability of traumatic lumbar puncture in the following procedure. Sci Rep [Internet]. 2023 Dec 1 [cited 2025 Mar 26];13(1). Available from: https://pubmed.ncbi.nlm.nih.gov/37949913/
18. Pessano S, Bruschettini M, Prescott MG, Romantsik O. Positioning for lumbar puncture in newborn infants. Cochrane Database Syst Rev [Internet]. 2023 Oct 23 [cited 2025 Mar 24];2023(10):CD015592. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10591282/
19. Bhagat RP, Amlicke M, Steele F, Fishbein J, Kusulas M. Retrospective study comparing success rates of lumbar puncture positions in infants. Am J Emerg Med [Internet]. 2022 Jun 1 [cited 2025 Mar 26];56:228–31. Available from: https://pubmed.ncbi.nlm.nih.gov/35462151/
20. Ferdosian F, Fallah R, Dehghani Z. Comparison of success rates in performing lumbar puncture and reduction of its anxiety and pain between standard sitting and lateral decubitus positions in 1 to 5-year-old children. Iran J Pediatr Hematol Oncol. 2020.
21. Roehr CC, Marshall AS, Scrivens A, Sadarangani M, Williams R, Yong J, et al. Techniques to increase lumbar puncture success in newborn babies: the NeoCLEAR RCT. Health Technol Assess [Internet]. 2023 Dec 1 [cited 2025 Mar 25];27(33):1–97. Available from: https://pubmed.ncbi.nlm.nih.gov/38149666/
22. Zorrilla-Vaca A, Kaur Makkar J. Effectiveness of lateral decubitus position for preventing post-dural puncture headache: a meta-analysis. Pain Physician [Internet]. 2017;20:521–9. Available from: www.painphysicianjournal.com
23. Hanson AL, Schunk JE, Corneli HM, Soprano JV. A randomized controlled trial of positioning for lumbar puncture in young infants. Pediatr Emerg Care [Internet]. 2016;32(8):504–7. Available from: http://dx.doi.org/10.1097/pec.0000000000000469
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Akash
Department of Pediatrics, KIMS, Bangalore
Dr Girish N
Professor, Department of Pediatrics, KIMS, Bangalore
Dr Shreeya Joshi
Department of Pediatrics, KIMS, Bangalore
