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