This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (31)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Hematology/ Hematologic Malignancies  • Leukemias/ Lymphomas  • Alert me on articles by topic  Social Bookmarking   What's this?

Scott C. Howard, MD, MS; Amar J. Gajjar, MD; Cheng Cheng, PhD; Stephen B. Kritchevsky, PhD; Grant W. Somes, PhD; Patricia L. Harrison, MPH; Raul C. Ribeiro, MD; Gaston K. Rivera, MD; Jeffrey E. Rubnitz, MD, PhD; John T. Sandlund, MD; Alberto J. de Armendi, MD; Bassem I. Razzouk, MD; Ching-Hon Pui, MD

JAMA. 2002;288:2001-2007.

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 x 10³/µL or more vs less than 100 x 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 x 10³/µL or less. Modifiable risk factors include procedural factors reflected in treatment era, platelet count of 100 x 10³/µL or less, an interval of 15 days or less between LPs, and a less experienced practitioner.

Author Affiliations: Departments of Hematology/Oncology (Drs Howard, Gajjar, Ribeiro, Rivera, Rubnitz, Sandlund, Razzouk, and Pui), Biostatistics (Dr Cheng and Ms Harrison), Pathology (Dr Pui), and Anesthesia (Dr de Armendi), St Jude Children's Research Hospital, and Departments of Pediatrics (Drs Howard, Gajjar, Ribeiro, Rivera, Rubnitz, Sandlund, Razzouk, and Pui) and Preventive Medicine (Drs Kritchevsky and Somes), University of Tennessee Health Science Center, Memphis.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Lumbar Puncture
JAMA. ;288():2070-2070.
 

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Treating Childhood Acute Lymphoblastic Leukemia without Cranial Irradiation
Pui et al.
NEJM 2009;360:2730-2741.
ABSTRACT | FULL TEXT  

Factors Associated with Traumatic Fluoroscopy-Guided Lumbar Punctures: A Retrospective Review
Yu et al.
Am. J. Neuroradiol. 2009;30:512-515.
ABSTRACT | FULL TEXT  

High Interleukin-15 Expression Characterizes Childhood Acute Lymphoblastic Leukemia With Involvement of the CNS
Cario et al.
JCO 2007;25:4813-4820.
ABSTRACT | FULL TEXT  

Treatment of Acute Lymphoblastic Leukemia
Pui and Evans
NEJM 2006;354:166-178.
FULL TEXT  

Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment
Pui
ASH Education Book 2006;2006:142-146.
ABSTRACT | FULL TEXT  

Childhood and Adolescent Lymphoid and Myeloid Leukemia
Pui et al.
ASH Education Book 2004;2004:118-145.
ABSTRACT | FULL TEXT  

Results of Therapy for Acute Lymphoblastic Leukemia in Black and White Children
Pui et al.
JAMA 2003;290:2001-2007.
ABSTRACT | FULL TEXT  

Racial Differences in Rates of Traumatic Lumbar Puncture
Vachon
JAMA 2003;289:548-548.
FULL TEXT  

Toward Optimal Central Nervous System-Directed Treatment in Childhood Acute Lymphoblastic Leukemia
Pui
JCO 2003;21:179-181.
FULL TEXT