While we are trashing common misperceptions about LPs...
1. Where is there any evidence of a causal link between performing an
LP and developing meningitis? Can we please eliminate the discussion of
infection as a "risk" of doing an LP? I believe that, historically, someone
noted that a few patients developed meningitis after performing an LP,
and this was cited as a cause and effect type of situation. We now
know that meningitis develops from baceteremia (in most cases) and is
not the result of performing an LP. If the latter were the case, we would
be seeing hundreds of cases of Staph. aureus and Staph epidermidis
meningitis yearly at every large pediatric center. It just doesn't happen.
2. Paralysis is not a risk in children.
3. Herniation is a real risk if an LP is performed when contraindicated.
Herniation after an LP, in the case of meningitis, may or may not be
causally associated, as was nicely discussed on this list about 6 months
4. Meningitis is a life-threatening illness with an easy diagnosis (LP) and
5. The only real risks to the patient for whom an P is not contraindicated
are pain, which should be treated appropriately with local anesthesia
and, perhaps, sedation, and bruising of the skin. Epidural hematoma has
not been reported in children, to my knowledge. Spinal headache may
ocur in the older child.
Given # 4, one would be a fool NOT to perform an LP, with or without
parental consent, if indicated. This is one of the true emergencies in
pediatrics and implied consent should be considered present (what
would a reasonable parent want done?). Based on the arguments
above, it would also appear that any reasonable jury could not find a
physician culpable for any perceived bad outcome except herniation, in
which case all the consent forms in the world would not protect you.
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