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Bed rest after lumbar puncture
  1. Stewart Teece, Clinical Research Fellow,
  2. Ian Crawford, Research Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether a period of bed rest reduces the incidence of headache or other complications in patients undergoing diagnostic lumbar puncture. Altogether 85 papers were found using the reported search, of which five presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Stewart Teece,Clinical Research FellowChecked by Ian Crawford, Research Fellow

    Clinical scenario

    A 27 year old woman attends the emergency department with a two day history of headache with mild neck stiffness. She appears otherwise well. Her CT scan is normal and you feel that if a lumbar puncture is normal she can be discharged. The duty physician advises you that the patient will require four hours bed rest after the lumbar puncture. The duty anaesthetist overhears and says that the patient will be able to go home immediately. You wonder if either of them is right.

    Three part question

    In [patients undergoing diagnostic lumbar puncture] does [a period of bed rest] reduce [the incidence of headache or other complications].

    Search strategy

    Medline 1966 to 06/02 using the Ovid Interface. {[exp spinal puncture OR (spinal adj5 tap).af OR (spinal adj5 puncture).af OR (spinal adj5 injection).af OR (lumbar adj5 tap).af OR (lumbar adj5 puncture).af OR (lumbar adj5 injection).af OR (dural adj5 tap).af OR (dural adj5 puncture).af OR (dural adj5 injection).af] AND [exp posture OR posture.af OR supine.af OR flat.af OR immobilis$.af OR recumben$.af OR (bed adj5 rest).af] AND [exp headache OR exp headache disorders OR headache.af]} LIMIT to human AND English Language.

    Search outcome

    Altogether 85 papers were found five of which were relevant to the three part question. These are shown in table 6.

    Table 6

    Comment(s)

    Most of the papers have found no statistical significance between the two groups. A rough calculation based on the data available shows that ambulant patients developed headache 31.7% (95% CI 27.4 to 36.1) of the time while those having bed rest suffered from this symptom 35.8% (95% CI 31.3 to 40.3) of the time. The confidence intervals overlap. Any difference between the two groups is likely to be so small that the sample size necessary to reveal it would be huge. The studies excluded patients with preceding headache. However, the question posed is about a patient undergoing a lumbar puncture to aid in the diagnosis of headache. A study by Kuntz et al* has shown a 21% higher incidence of post lumbar puncture symptoms in those with preceding headache. A further study is therefore required to assess the question in patients with pre-existing headache.

    CLINICAL BOTTOM LINE

    Bed rest does not decrease the incidence of post lumbar puncture headache.

    Report by Stewart Teece,Clinical Research FellowChecked by Ian Crawford, Research Fellow

    References

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