Journal Club Summary

Methodology Score: 4/5
Usefulness Score: 5/5

Nath S, et al. Lancet. 2018 Mar 24;391(10126):1197-1204

Question and Methods: This meta-analysis sought to determine, in lumbar punctures, whether atraumatic or conventional (traumatic) spinal needles were superior in terms of their complication rates.

Findings: Atraumatic spinal needles were superior to conventional needles in every outcome assessed, including decreased postdural-puncture headache (RR 0.4) while having no difference in efficacy

Limitations: Limitations include a lack of cost-effectiveness analysis, no studies based in the Emergency Department, and no quantitative assessment of ease of use between needles.

Interpretation: For many lumbar puncture indication across a wide set of patients, atraumatic spinal needles should be your first line to reduce post LP complications without sacrificing efficacy.

By: Dr. Matthew Lipinski  

Epi lesson: Systematic review versus meta-analysis

To avoid the biases of an unsystematic review (i.e. review article), a systematic review incorporates explicit inclusion and exclusion criteria, a comprehensive search for the evidence, and a summary of the results according to explicit rules. When a systematic review pools data across studies to provide a quantitative estimate of the treatment effect, this is called a meta-analysis. When the data cannot be pooled, the systematic review will provide a narrative synthesis of the evidence.

Dr. Ian Stiell    

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.