to evaluate trends in LP performance among U.S. children’s hospitals to assess how risk stratification algorithms impact pediatric resident trainee exposure to lumbar puncture (LP).
We quantified LPs for emergency department (ED) and inpatient encounters at 29 U.S. children’s hospitals from 2009 to 2019. LP was defined by either a LP procedure code or cerebrospinal fluid culture billing code. Temporal trends and hospital variation in LP were assessed using logistic regression analysis.
A total of 215,030 LPs were performed during the study period (0.8% of all encounters). 26,523 and 16,696 LPs were performed in the 2009 and 2018 academic years, respectively (overall 37.1% reduction, per-year odds ratio [OR] 0.935, 95% confidence interval [CI] 0.922, 0.948, P < .001), and the rate of LP decreased from 10.9 per 1,000 hospital encounters to 6.0 per 1,000 over the same period.
LP rates have declined across U.S. children’s hospitals over the past decade, potentially resulting in reduced clinical exposure for pediatric resident trainees. Improved procedural simulation during residency may augment the clinical experience.

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