Table 6
Author, date, and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Carbaat PA and van Crevel H, 1981, Netherlands100 neurological patients undergoing LP all done by same investigator with 18G needle. 50 ambulant, 50-24 hour bed rest.Controlled trialIncidence of headacheambulant- 38% bed rest- 36% (NS)p not stated small numbers
Dieterich M and Brandt T, 1985, Germany160 patients undergoing LP for ? MS. 78 with 30 minute prone with head down tilt, 82 immediately ambulant. 20G and 22G needles usedControlled trialIncidence of headacheambulant 41% head down tilt 44%Statistical significance not assessed. Patients with prior headache excluded. Substudy of needle size may complicate results. Difficult LP excluded.
Headache described as aboveambulant 18% head down tilt 14%
Vilming ST et al, 1988, Norway150 men 150 women for neurological investigation. 75 men and 75 women ambulant. Remainder 3 h prone then 3 h supine. All 22G using needle.PRCTHeadacheambulant 35% bed rest 39% (NS)Significance headache calculated but not stated. Patients with preceding headache excluded.
Nauseaambulant 23% bed rest 13% (p<0.05)
Spriggs DA et al, 1992, UK110 patients undergoing diagnostic LP. 54 ambulant 56 bed rest for 4 hoursPRCTIncidence of headacheAmbulant 32% Bed rest 31% (NS)Statistical significance assessed but not given. Small discrepancies between two groups for needle size and operator experience. Patients with headache excluded.
Vimala J et al, 1998, Country not stated but ? India204 patients undergoing diagnostic LP. 100 ambulant 104 24 hour bed rest.PRCTIncidence of headacheambulant 15% (95% CI 12 to 22%) bed rest 18% (95% CI 8 to 22%)Randomisation method unclear but possibly highly flawed. Discrepancies in needle size and operator experience.
Headache considered severeAmbulant 57% Bed rest 12% (p=0.02)