TY  - JOUR
T1  - RIsk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia
AU  - Howard SC, Gajjar AJ, Cheng C, et al
Y1  - 2002/10/23
N1  - 10.1001/jama.288.16.2001
JO  - JAMA
SP  - 2001
EP  - 2007
VL  - 288
IS  - 16
N2  - Context 
                  Traumatic or bloody lumbar puncture (LP) reduces the diagnostic value
of the procedure and may worsen the outcome of patients with acute lymphoblastic
leukemia (ALL). Little is known about the risk factors for traumatic and bloody
LP.Objectives 
                  To determine the risk factors for traumatic and bloody LP.Design, Setting, and Patients 
                  Retrospective cohort study of 956 consecutive patients with newly diagnosed
childhood ALL who were treated at a pediatric cancer center between February
1984 and July 1998.Interventions 
                  All patients underwent a diagnostic LP followed by a median of 4 LPs
to instill intrathecal chemotherapy.Main Outcome Measure 
                  Traumatic LP was defined as an LP in which cerebrospinal fluid contained
at least 10 red blood cells (RBCs) per microliter and bloody LP as one in
which the cerebrospinal fluid contained at least 500 RBCs per microliter.Results 
                  Of the 5609 LPs evaluated, 1643 (29%) were traumatic and 581 (10%) were
bloody. The estimated odds ratios (ORs) and 95% confidence intervals (CIs)
for traumatic LP were 1.5 (95% CI, 1.2-1.8) for black vs white race, 2.3 (95%
CI, 1.7-3.0) for age younger than 1 year vs 1 year or older, 1.4 (95% CI,
1.2-1.7) for early vs recent (dedicated procedure area and general anesthesia)
treatment era, 1.5 (95% CI, 1.2-1.8) for platelet count of 100 × 103/µL or more vs less than 100 × 103/µL,
10.8 (95% CI, 7.7-15.2) for short (1 day) vs longer (>15 days) interval since
the previous LP, and 1.4 (95% CI, 1.1-1.8) for the least vs the most experienced
practitioners. Analyses for bloody LP yielded similar results.Conclusions 
                  The unmodifiable risk factors for traumatic and bloody LP include black
race, age younger than 1 year, a traumatic or bloody previous LP performed
within the past 2 weeks, and a previous LP performed when the platelet count
was 50 × 103/µL or less. Modifiable risk factors include
procedural factors reflected in treatment era, platelet count of 100 ×
103/µL or less, an interval of 15 days or less between LPs,
and a less experienced practitioner.
SN  - 0098-7484
M3  - doi: 10.1001/jama.288.16.2001
UR  - http://dx.doi.org/10.1001/jama.288.16.2001
ER  -