The following is a summary of “An unexpected effect of traumatic and bloody lumbar puncture among patients with primary headaches in emergency department,” published in the June 2023 issue of Emergency Medicine by An, et al.

For a study, researchers sought to investigate the potential correlation between traumatic tap and the occurrence of post-dural puncture headache (PDPH) after lumbar puncture (LP) in patients who had been diagnosed with primary headache at the time of their release from the emergency department (ED).

They conducted a retrospective review of medical records for patients who presented to a single tertiary emergency department (ED) with a headache and underwent lumbar puncture (LP) for cerebrospinal fluid (CSF) analysis between January 2012 and January 2022. The study included patients who met the post-dural puncture headache (PDPH) criteria and revisited the ED or outpatient clinic within 2 weeks after discharge. The patients were categorized into three groups based on their CSF red blood cell (RBC) counts: group 1 with CSF RBC <10 cells/μL, group 2 with CSF RBC counts between 10 and 100 cells/μL, and group 3 with CSF RBC count≥100 cells/μL. The primary outcome of interest was to compare the differences in CSF RBC counts among patients who revisited the ED or outpatient clinic within 2 weeks after undergoing LP. Secondary outcomes included assessing the admission rate and identifying potential risk factors for developing PDPH, such as sex, age, needle size used during LP, and CSF pressure.

The study collected data from 112 patients who underwent lumbar puncture (LP). Among these patients, 39 (34.8%) reported experiencing post-dural puncture headache (PDPH), and 40 (35.7%) were admitted to the hospital. The median red blood cell count in cerebrospinal fluid (CSF RBC count) was 10 cells/μL, with an interquartile range of 2 to 100.8 cells/μL.

A one-way analysis of variance test was conducted to compare the mean differences among three groups based on CSF RBC counts (group 1: CSF RBC <10 cells/μL; group 2: 10–100 cells/μL; group 3: ≥100 cells/μL). The results showed no significant differences in age, headache duration before LP, platelet counts, prothrombin time (PT), or activated partial thromboplastin time (aPTT). However, there were notable differences in the number of admitted patients between the three groups (30 vs. 7 vs. 3, P < 0.001) and in the incidence of PDPH (29 vs. 6 vs. 4, P < 0.003). When comparing the group of patients with PDPH to those without PDPH, there were significant age differences (28.7 ± 8.4 years vs. 36.9 ± 18.4 years, P = 0.01) and the admission rate (85% vs. 9%, P < 0.001).

The study suggested that traumatic LP may unexpectedly reduce the occurrence rate of PDPH, leading to a significantly reduced admission rate for PDPH in patients with primary headaches. However, the sample size was relatively small, and further studies were needed to explore the relationship between traumatic LP and PDPH.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001547