Is first attempt at pediatric lumbar puncture more successful with ultrasound guidance?

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Why is this study important?

Lumbar puncture (LP) is a routine emergency department (ED) procedure whether obtaining cerebrospinal fluid (CSF) to diagnose meningitis or measuring opening pressure to diagnose benign intracranial hypertension. Regardless of the clinical scenario, first attempt LP failures are common and can lead to repeat LP attempts, delays to diagnosis, unnecessary antibiotic therapy and even hospital admission. This study aimed to determine if ultrasound-assisted-LP (UALP) has a higher probability of first-attempt success of obtaining a non-bloody CSF sample compared to standard LP (SLP) using palpation for landmark identification.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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