Measuring Quality and Safety for Lumbar Punctures: Introducing the Atraumatic Index and the Traumatic Index

1Cedars‐Sinai Medical Center, Los Angeles, CA
2Cedars‐Sinai Medical Center, Los Angeles, CA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 68

Background:

The “champagne tap” is still considered the gold standard for lumbar puncture (LP) success. The Gertie‐Marx® (GM) atraumatic LP needle has been shown in multiple studies to be superior to the standard Quinke needle (QN) for reducing post‐lumbar puncture headache. In addition, the blunt‐tip design of the GM results in less tissue trauma, which generates fewer red blood cells (RVCs) in the CSF and increases the quality of the analysis. As we prepare to lead the transition at our institution from the QN to the GM for LPs, we evaluated the experience of a single high‐volume proceduralist using both needles.

Methods:

Retrospective analysis was done on all LPs performed by 1 proceduralist using either the QN or the GM between October 1, 2001, and December 31, 2007. We created 2 indices to serve as surrogate markers for the “perfect” LP: the atraumatic index (ATI), a marker for quality, defined as the number of LPs that result in 0 RBCs in any tube divided by the total number of LPs performed; the traumatic index (TI), a marker for safety, defined as the number of LPs that produced either blood‐tinged or bloody CSF divided by the total number of LPs performed.

Figure 1. Gertie‐Marx needle.

Results:

A total of 1165 LPs were completed during the 6‐year time frame. Of those 1165 LPs, 302 were performed with a QN, and 782 were performed with the GM; the remaining 85 cases were started with GM and converted to the QN for technical reasons. Of the 302 cases performed with the QN, 64 had 0 RBCs (ATI = 21%). By contrast, of the 782 LPs performed with the GM, 280 resulted in 0 RBCs (ATI = 36%). Fifteen of 85 cases that had to be converted from the GM to the QN had 0 RBCs, for an ATI of 20% (comparable to the QN ATI). The TI for the QN was 9.5%, 4 times higher than the TI for the GM (2.4%). For the 85 conversion cases, the TI was 13% (11 cases).

Conclusions:

The ATI and TI can serve as useful indices for quantifying the quality and safety of LPs, and our data correlate with prior studies confirming the superiority of the GM. The overall utility of these indices proved to be severalfold: (1) they can be easily collected without requiring clinical follow‐up; (2) they are meaningful even with a small number of procedures; (3) they allow individual operators or physician groups to trend their own performance; and (4) they may prove useful for tracking the eventual systemwide transition from the QN to the superior GM device in order to improve patient care.

Author Disclosure:

B. Rosen, none; M. Ault, none.

To cite this abstract:

Rosen B, Ault M. Measuring Quality and Safety for Lumbar Punctures: Introducing the Atraumatic Index and the Traumatic Index. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 68. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/measuring-quality-and-safety-for-lumbar-punctures-introducing-the-atraumatic-index-and-the-traumatic-index/. Accessed June 17, 2019.

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