Abstract
Objectives To evaluate the contemporary indications, cerebrospinal fluid findings, and complications of lumbar punctures in a metropolitan Australian health service.
Methods A retrospective electronic medical records audit of lumbar punctures in 525 adults within three acute hospitals between 1 July 2018 and 30 June 2019 was performed. Our main outcome measures included the frequency of indication for lumbar puncture by category, normal vs abnormal cerebrospinal fluid for each indication category, and the frequency, severity, and type of complications of lumbar punctures.
Results The most common indications were acute severe headache with features of meningism (156 procedures, 29.7%) and encephalopathy (128 procedures, 24.4%). Other major indications for lumbar puncture included investigation of a suspected neuroinflammatory condition (83; 15.8%), administration of intrathecal chemotherapy (59; 11.2%), thunderclap headache (38;7.2%), chronic headache (23; 4.4%), and suspected malignancy (18; 3.4%). The yield of abnormal results varied by indication, with lumbar punctures for acute severe headache with features of meningism yielding abnormal results in 85 cases (54.5%), with specific Gram stain or PCR findings in 27 cases (17.3%). The majority of the complications were minor (45; 8.6%), and most frequently consisted of post-dural puncture headache (PDPH). The 9 more severe complications were all related to severity of PDPH, and 2 (0.4%) of these required a blood patch.
Conclusion In the era of an increased reliance on neuroimaging, lumbar puncture has a high diagnostic yield with a low rate of major complications. The most common complication is PDPH which is mild and self-limiting in most cases.
