Documentation of cerebrospinal fluid opening pressure and other important aspects of lumbar puncture in acute headache

Russell Martin Hewett (1) , Carl Counsell (2)

1 Neurology Specialist Registrar, Department of Clinical Neurosciences, Western General Hospital
2 Clinical Senior Lecturer & Honorary Consultant Neurologist, Division of Applied Health Sciences, University of Aberdeen

Background: Measuring CSF opening pressure by lumbar puncture is an essential tool in the investigation of patients with acute headache. Aim: To assess documentation of opening CSF pressure in those with acute headache undergoing lumbar puncture. General documentation of the procedure and CSF investigations was also assessed. Methods: Retrospective review of medical records of patients admitted to a teaching hospital Acute Medical Admissions Unit over a three month period with a presenting complaint of headache. Results: 106 patients presented with headache of whom 48 patients had at least one LP attempted. Only 41 patients (85%, 95% CI 72-94) had their LP documented. Out of 47 patients that had a successful LP, 22 (47%) had a recorded opening pressure. 18 (32%) of all patients had their position recorded, with 7 (15%) patients having had position and opening pressure documented. 20 patients (43%) had the appropriate results documented. 12 patients (31%) had paired venous blood glucose measured. Conclusions: Documentation of a lumbar puncture for headache in the acute setting was generally poor. CSF opening pressure measurement was frequently omitted and no appropriate action taken if high. Paired venous blood glucose was rarely measured. Acute physicians may benefit from a proposed protocol and documentation sticker.

Mots clés: Medicine

Russell Martin Hewett, Carl Counsell. Documentation of cerebrospinal fluid opening pressure and other important aspects of lumbar puncture in acute headache. International Journal of Clinical Practice, 2010, 64 (7), pp.930. ⟨10.1111/j.1742-1241.2010.02415.x⟩. ⟨hal-00552657⟩