Evidence map›Paper›PMID 40686417›Full record

ArticleJournal of hospital medicine2026

Increased lumbar puncture success using a paramedian approach: A retrospective cohort study.

Jacob Wagner, Kiril Dimitrov, Zachary Lauer, Swati Jain, Omar Jibril, Zach Kaltenborn, Aditya Kler, Andrew Olson, Justin Clark, Kyle Rudser and 1 more

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In one paragraph

Article in Journal of hospital medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Jacob WagnerDivision of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota, USA.ORCID 0009-0008-8664-5286
Kiril DimitrovDivision of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Zachary LauerDivision of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota, USA.ORCID 0009-0003-1228-2164
Swati JainDivision of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Omar JibrilDivision of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Zach KaltenbornDivision of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota, USA.ORCID 0000-0002-2250-6788
Aditya KlerDivision of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Andrew OlsonDivision of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Justin ClarkDivision of Biostatistics & Health Data Science, University of Minnesota, Minneapolis, Minnesota, USA.
Kyle RudserDivision of Biostatistics & Health Data Science, University of Minnesota, Minneapolis, Minnesota, USA.
Matthew YocumDivision of Hospital Medicine, University of California San Francisco, San Francisco, California, USA.ORCID 0000-0003-4863-6406

Funding

University of Minnesota Clinical and Translational Science Institute (UMN CTSI)UM1TR004405 · NCATS · UNIVERSITY OF MINNESOTA · PI Bruce R Blazar, Damien A Fair · 2023 to 2026
$30.8M
Clinical and Translational Science Institute, University of Minnesota UM1TR004405NCATS NIH HHS UM1 TR004405
6 · The paper itself

Abstract

backgroundLumbar puncture (LP) is frequently necessary in hospitalized patients for diagnostic and therapeutic purposes. Traditional landmark identification by palpation of the lumbar spine and pelvis can see significant failure rates. A paramedian approach is an accepted, though less frequently used technique associated with higher success rates for spinal access in anesthesia when aided by ultrasound. Similarly, point-of-care ultrasound (POCUS) of the paramedian acoustic window may help guide a paramedian LP technique.

objectiveTo compare the probability of success before and after the implementation of a standardized training curriculum for lumbar punctures (LPs) performed by the Hospital Medicine Procedure Service (HMPS).

methodsThe HMPS at the University of Minnesota Medical Center (UMMC), a large tertiary academic medical center, implemented a standardized training for an ultrasound-assisted paramedian (USPM) approach to all bedside lumbar punctures (LPs) and then conducted a retrospective review comparing success rates between the traditional midline (ML) and USPM approaches.

resultsA total of 269 LPs were performed on hospitalized patients. Before standardization, the probability of a successful LP was 72.6% using ML approach. After standardization, using a USPM approach, the probability of a successful LP was 85.4%. The probability of a successful procedure was 13.6 (95% confidence interval: 2.8, 24.4, p = .014) percentage points higher for the USPM approach when compared to the ML approach and accounting for sex, age, BMI, and if the LP was for chemotherapy.

conclusionsInstitutions with a HMPS should consider transitioning to use of the USPM approach for bedside LPs, which is associated with a higher probability of success and reduced utilization of more resource-intensive hospital services, such as Interventional Radiology or Neuroradiology.

Indexed as

Point-of-Care SystemsSpinal PunctureUltrasonography, InterventionalAdultAgedAged, 80 and overCohort StudiesFemaleHumansMaleMiddle AgedRetrospective Studies

Identifiers

PMID40686417
PMCPMC12747465

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.