Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia

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

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)2001-2007
Number of pages7
JournalJournal of the American Medical Association
Volume288
Issue number16
DOIs
StatePublished - Oct 23 2002

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Spinal Puncture
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Confidence Intervals
Platelet Count
Cerebrospinal Fluid
Erythrocytes
General Anesthesia
Cohort Studies

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia. / Howard, Scott; Gajjar, Amar J.; Cheng, Cheng; Kritchevsky, Stephen B.; Somes, Grant W.; Harrison, Patricia L.; Ribeiro, Raul C.; Rivera, Gaston K.; Rubnitz, Jeffrey E.; Sandlund, John T.; De Armendi, Alberto J.; Razzouk, Bassem I.; Pui, Ching Hon.

In: Journal of the American Medical Association, Vol. 288, No. 16, 23.10.2002, p. 2001-2007.

Research output: Contribution to journalArticle

Howard, S, Gajjar, AJ, Cheng, C, Kritchevsky, SB, Somes, GW, Harrison, PL, Ribeiro, RC, Rivera, GK, Rubnitz, JE, Sandlund, JT, De Armendi, AJ, Razzouk, BI & Pui, CH 2002, 'Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia', Journal of the American Medical Association, vol. 288, no. 16, pp. 2001-2007. https://doi.org/10.1001/jama.288.16.2001
Howard, Scott ; Gajjar, Amar J. ; Cheng, Cheng ; Kritchevsky, Stephen B. ; Somes, Grant W. ; Harrison, Patricia L. ; Ribeiro, Raul C. ; Rivera, Gaston K. ; Rubnitz, Jeffrey E. ; Sandlund, John T. ; De Armendi, Alberto J. ; Razzouk, Bassem I. ; Pui, Ching Hon. / Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia. In: Journal of the American Medical Association. 2002 ; Vol. 288, No. 16. pp. 2001-2007.
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abstract = "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.",
author = "Scott Howard and Gajjar, {Amar J.} and Cheng Cheng and Kritchevsky, {Stephen B.} and Somes, {Grant W.} and Harrison, {Patricia L.} and Ribeiro, {Raul C.} and Rivera, {Gaston K.} and Rubnitz, {Jeffrey E.} and Sandlund, {John T.} and {De Armendi}, {Alberto J.} and Razzouk, {Bassem I.} and Pui, {Ching Hon}",
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T1 - Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia

AU - Howard, Scott

AU - Gajjar, Amar J.

AU - Cheng, Cheng

AU - Kritchevsky, Stephen B.

AU - Somes, Grant W.

AU - Harrison, Patricia L.

AU - Ribeiro, Raul C.

AU - Rivera, Gaston K.

AU - Rubnitz, Jeffrey E.

AU - Sandlund, John T.

AU - De Armendi, Alberto J.

AU - Razzouk, Bassem I.

AU - Pui, Ching Hon

PY - 2002/10/23

Y1 - 2002/10/23

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.

AB - 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.

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