Original Research

Clinical review of the clinical necessity of lumbar punctures performed on adults at National District Hospital Emergency Department

Suné Geldenhuys, Cecil Boltman, Wilhelm J. Steinberg, Johan Botes, Cornel van Rooyen
South African Family Practice | Vol 64, No 1 : Part 3| a5435 | DOI: https://doi.org/10.4102/safp.v64i1.5435 | © 2022 Suné Geldenhuys, Cecil Boltman, Wilhelm J. Steinberg, Johan Botes, Cornel van Rooyen | This work is licensed under CC Attribution 4.0
Submitted: 18 October 2021 | Published: 19 August 2022

About the author(s)

Suné Geldenhuys, Department of Family Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
Cecil Boltman, Department of Family Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
Wilhelm J. Steinberg, Department of Family Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
Johan Botes, Department of Family Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
Cornel van Rooyen, Department of Biostatistics, Faculty of Health Sciences, School of Biomedical Sciences, University of the Free State, Bloemfontein, South Africa

Abstract

Background: Previous studies have found that indications for lumbar punctures (LPs) are managed differently, which raises the question of whether all LPs performed are clinically necessary. This study aimed to determine whether unnecessary (clinically not indicated) LPs were being performed at a district hospital in the Free State, South Africa.

Method: This was a retrospective descriptive study. A list from the National Health Laboratory Service (NHLS) was used to identify all patients on whom an LP was performed in the adult emergency department of National District Hospital (NDH) in Bloemfontein, from 1 January 2018 to 30 June 2018. Data were captured on a data sheet and included demographic information, clinical signs and symptoms the patients presented with and the cerebrospinal fluid results.

Results: A total of 364 patients fit the inclusion criteria. Of these patients, 97 files (26.6%) could not be found, patient gender and LP results could be retrieved from the NHLS barcodes. After reviewing the presenting symptoms and signs captured on the 267 files, the primary researcher considered 150 (56.4%) of the LPs performed to have been carried out unnecessarily. From the total population of 364 patients, 246 (67.6%) of the LP results were normal. Only 118 (32.4%) of the LPs performed showed some form of central nervous system pathology. Of the 150 LPs assessed to have been unnecessarily performed, 124 (84.0%) were normal.

Conclusion: This retrospective review indicates that a high percentage of LPs that were clinically not indicated were performed at NDH during the study period.


Keywords

lumbar puncture; district hospital; prevalence; clinically indicated; necessity

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