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Abstract

Purpose of review:

To review the literature and describe techniques to use ultrasound to guide performance of lumbar puncture (LP).

Recent findings:

Ultrasound evaluation of the lumbar spine has been shown in randomized trials to improve LP success rates while reducing the number of attempts and the number of traumatic taps.

Summary:

Ultrasound mapping of the lumbar spine reveals anatomical information that is not obtainable by physical examination, including depth of the ligamentum flavum, width of the interspinous spaces, and spinal bone abnormalities, including scoliosis. Using static ultrasound, the lumbar spine anatomy is visualized in transverse and longitudinal planes and the needle insertion site is marked. Using real-time ultrasound guidance, the needle tip is tracked in a paramedian plane as it traverses toward the ligamentum flavum. Future research should focus on efficient methods to train providers, cost-effectiveness of ultrasound-guided LP, and the role of new needle-tracking technologies to facilitate the procedure.

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REFERENCES

1.
Edwards C, Leira EC, Gonzalez-Alegre P. Residency training: a failed lumbar puncture is more about obesity than lack of ability. Neurology 2015;84:e69–e72.
2.
Bogin IN, Stulin ID. Application of the method of 2-dimensional echospondylography for determining landmarks in lumbar punctures [in Russian]. Zh Nevropatol Psikhiatr Ime S S Korsakova 1971;71:1810–1811.
3.
Grau T, Leipold R, Conradi R, Martin E, Motsch J. Ultrasonography and peridural anesthesia: technical possibilities and limitations of ultrasonic examination of the epidural space [in German]. Anaesthesist 2001;50:94–101.
4.
Grau T, Leipold RW, Conradi R, Martin E. Ultrasound control for presumed difficult epidural puncture. Acta Anaesthesiol Scand 2001;45:766–771.
5.
Grau T, Leipold RW, Horter J, Conradi R, Martin E, Motsch J. The lumbar epidural space in pregnancy: visualization by ultrasonography. Br J Anaesth 2001;86:798–804.
6.
Grau T, Leipold RW, Horter J, Conradi R, Martin EO, Motsch J. Paramedian access to the epidural space: the optimum window for ultrasound imaging. J Clin Anesth 2001;13:213–217.
7.
Grau T, Leipold RW, Conradi R, Martin E, Motsch J. The visualisation of dura perforation and blood patches with ultrasound [in German]. Anasthesiol Intensivmed Notfallmed Schmerzther 2002;37:149–153.
8.
Grau T, Conradi R, Martin E, Motsch J. Ultrasound and local anaesthesia: part III: ultrasound and neuroaxial local anaesthesia [in German]. Anaesthesist 2003;52:68–73.
9.
Pisupati D, Heyming TW, Lewis RJ, Peterson MA. Effect of ultrasonography localization of spinal landmarks on lumbar puncture in the emergency department. Ann Emerg Med 2004;44:S83.
10.
Nomura JT, Leech SJ, Shenbagamurthi S, et al. A randomized controlled trial of ultrasound-assisted lumbar puncture. J Ultrasound Med 2007;26:1341–1348.
11.
Lee WS, Jeong WJ, Yi HY, Ryu S, Lee JW, Kim SW. The usefulness of ultrasound-assisted lumbar puncture on adult patients in the emergency center: comparison with classic lumbar puncture. J Korean Soc Emerg Med 2008;19:562.
12.
Cho YC, Koo DH, Oh SK, Jeong WJ, Lee WS, You YH. Comparison of ultrasound-assisted lumbar puncture with lumbar puncture using palpation of landmarks in aged patients in an emergency center. J Korean Soc Emerg Med 2009;20:304.
13.
Mofidi M, Mohammadi M, Saidi H, et al. Ultrasound guided lumbar puncture in emergency department: time saving and less complications. J Res Med Sci 2013;18:303–307.
14.
Fox JC, Kinney A, Youssefian A, et al. Success of lumbar puncture after using ultrasound to identify landmarks. Acad Emerg Med 2013;20:S11.
15.
Peterson MA, Pisupati D, Heyming TW, Abele JA, Lewis RJ. Ultrasound for routine lumbar puncture. Acad Emerg Med 2014;21:130–136.
16.
Shaikh F, Brzezinski J, Alexander S, et al. Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta-analysis. BMJ 2013;346:f1720.
17.
Perlas A. Evidence for the use of ultrasound in neuraxial blocks. Reg Anesth Pain Med 2010;35:S43–S46.
18.
Stiffler KA, Jwayyed S, Wilber ST, Robinson A. The use of ultrasound to identify pertinent landmarks for lumbar puncture. Am J Emerg Med 2007;25:331–334.
19.
Sahota JS, Carvalho JC, Balki M, Fanning N, Arzola C. Ultrasound estimates for midline epidural punctures in the obese parturient: paramedian sagittal oblique is comparable to transverse median plane. Anesth Analg 2013;116:829–835.
20.
Gnaho A, Nguyen V, Villevielle T, Frota M, Marret E, Gentili ME. Assessing the depth of the subarachnoid space by ultrasound. Rev Bras Anestesiol 2012;62:520–530.
21.
Ferre RM, Sweeney TW. Emergency physicians can easily obtain ultrasound images of anatomical landmarks relevant to lumbar puncture. Am J Emerg Med 2007;25:291–296.
22.
Grau T, Bartusseck E, Conradi R, Martin E, Motsch J. Ultrasound imaging improves learning curves in obstetric epidural anesthesia: a preliminary study. Can J Anaesth 2003;50:1047–1050.
23.
Chin KJ, Perlas A, Chan V, Brown-Shreves D, Koshkin A, Vaishnav V. Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. Anesthesiology 2011;115:94–101.
24.
Furness G, Reilly MP, Kuchi S. An evaluation of ultrasound imaging for identification of lumbar intervertebral level. Anaesthesia 2002;57:277–280.
25.
Whitty R, Moore M, Macarthur A. Identification of the lumbar interspinous spaces: palpation versus ultrasound. Anesth Analg 2008;106:538–540.
26.
Amin WA, Abou Seada MO, Bedair E, Elkersh MM, Karunakaran E. Comparative study between ultrasound determination and clinical assessment of the lumbar interspinous level for spinal anesthesia. Middle East J Anaesthesiol 2014;22:407–412.
27.
Duniec L, Nowakowski P, Kosson D, Üazowski T. Use of ultrasound to determine the level of lumbar puncture in orthopaedic patients. Eur J Anaesthesiol 2012;29:119.
28.
Locks Gde F, Almeida MC, Pereira AA. Use of the ultrasound to determine the level of lumbar puncture in pregnant women. Rev Bras Anestesiol 2010;60:13–19.
29.
Ansari T, Yousef A, El Gamassy A, Fayez M. Ultrasound-guided spinal anaesthesia in obstetrics: is there an advantage over the landmark technique in patients with easily palpable spines? Int J Obstet Anesth 2014;23:213–216.
30.
Rizzoli P. Taking the sting out of lumbar puncture. BMJ 2013;346:f1734.
31.
Grau T, Leipold RW, Fatehi S, Martin E, Motsch J. Real-time ultrasonic observation of combined spinal-epidural anaesthesia. Eur J Anaesthesiol 2004;21:25–31.
32.
Brinkmann S, Tang R, Sawka A, Vaghadia H. Single-operator real-time ultrasound-guided spinal injection using SonixGPS: a case series. Can J Anaesth 2013;60:896–901.
33.
Chin KJ, Chan VW, Ramlogan R, Perlas A. Real-time ultrasound-guided spinal anesthesia in patients with a challenging spinal anatomy: two case reports. Acta Anaesthesiol Scand 2010;54:252–255.
34.
Conroy PH, Luyet C, McCartney CJ, McHardy PG. Real-time ultrasound-guided spinal anaesthesia: a prospective observational study of a new approach. Anesthesiol Res Pract 2013;2013:525818.
35.
Niazi AU, Chin KJ, Jin R, Chan VW. Real-time ultrasound-guided spinal anesthesia using the SonixGPS ultrasound guidance system: a feasibility study. Acta Anaesthesiol Scand 2014;58:875–881.
36.
Tran D, Kamani AA, Al-Attas E, Lessoway VA, Massey S, Rohling RN. Single-operator real-time ultrasound-guidance to aim and insert a lumbar epidural needle. Can J Anaesth 2010;57:313–321.
37.
Wong SW, Niazi AU, Chin KJ, Chan VW. Real-time ultrasound-guided spinal anesthesia using the SonixGPS(R) needle tracking system: a case report. Can J Anaesth 2013;60:50–53.
38.
Soni N, Arntfield R, Kory P. Point-of-Care Ultrasound. 1st ed. Philadelphia: Saunders; 2014.
39.
Sandoval M, Shestak W, Sturmann K, Hsu C. Optimal patient position for lumbar puncture, measured by ultrasonography. Emerg Radiol 2004;10:179–181.
40.
Bradbury CL, Singh SI, Badder SR, Wakely LJ, Jones PM. Prevention of post-dural puncture headache in parturients: a systematic review and meta-analysis. Acta Anaesthesiol Scand 2013;57:417–430.
41.
Arendt K, Demaerschalk BM, Wingerchuk DM, Camann W. Atraumatic lumbar puncture needles: after all these years, are we still missing the point? Neurologist 2009;15:17–20.
42.
Barsuk JH, Cohen ER, Caprio T, McGaghie WC, Simuni T, Wayne DB. Simulation-based education with mastery learning improves residents' lumbar puncture skills. Neurology 2012;79:132–137.

DISCLAIMER

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the NIH.
Letters to the Editor
28 September 2016
LETTER RE: Ultrasound guidance for lumbar puncture
Josh Torgovnick, MD, NYU Langone Medical Center

I read the article by Dr. Soni et al.1 line by line. Because of my association with a hospital at the epicenter of the AIDS epidemic I have performed many thousands of lumbar punctures for all of the usual reasons. Many patients were tapped repeatedly. I am right handed and so the L-P is performed with the patient in the left lateral decubitus position. This is essential to measure the opening pressure. I mark the back in the usual fashion using the line between the superior Iliac Crests to identify the L4-L5 interspace. I prefer the L2-L3 interspace for the procedure. Once identified I begin the procedure. I use the same words with each patient and prep and drape the patient in the same fashion each time. I use local anesthesia. Once I again have the L2 spinous process identified I keep my left thumb firmly pressed there for guidance, support and to distract the patient. The needle is advanced perpendicular to the skin and once it has passed the bone is at times angled cephalad. What I have described is a ritual. It is the ritual that makes the successful L-P and this can be taught.

Disclosures: The author reports no disclosures.

Reference

1. Soni N, Franco-Sadud R, Schnobrich D, et al. Ultrasound guidance for lumbar puncture. Neurol Clin Pract 2016;6:358-368.

28 September 2016
LETTER RE: Ultrasound guidance for lumbar puncture
Nitin K. Sethi, MD, New York-Presbyterian Hospital

I read with interest the Soni et al. article on the use of ultrasound guidance for lumbar puncture (LP). The authors advocate for routine use of ultrasound in all patients undergoing LP though they themselves highlight a recent randomized trial comparing routine use of ultrasound guided vs landmark-based techniques which failed to demonstrate a benefit of using ultrasound localization for LP insertion.1, 2 Who uses a cannon to kill a fly? An excess of what is necessary or appropriate for a particular end is not standard of care. The use of ultrasound for LP is neither cost-effective nor logistically possible in low- and middle-income countries. Instead of wasting precious resources in future studies looking at the effect of ultrasound in clinical decision making, emphasis should be on teaching LP clinical and procedural skills to residents in training. In the hands of an experienced operator, landmark-guided LP has a very high success rate. "See one, do one, teach one" is a long established medical adage and it shall be our folly to forget it.

Disclosures: N. Sethi serves as Associate Editor of The Eastern Journal of Neurology.

References

1. Soni NJ, Franco-Sadud R, Schnobrich D, et al. Ultrasound guidance for lumbar puncture. Neurol Clin Pract 2016;6:358-368.

2. Peterson MA, Pisupati D, Heyming TW, Abele JA, Lewis RJ. Ultrasound for routine lumbar puncture. Acad Emerg Med 2014; 21:130-136.

28 September 2016
AUTHORS RESPOND: Ultrasound guidance for lumbar puncture
Nilam J. Soni, MD, MSc, University of Texas Health Science Center
David M.Tierney, MD, Daniel Schnobrich, MD (Minneapolis, MN); Gerard Salame, MD (Denver, CO); Paul McHardy, MD (Toronto, Canada)

We appreciate the feedback on our article.1 The recent randomized trial by Peterson et al.2 did not find a difference between landmark-based vs. ultrasound-guided lumbar puncture, but some important limitations must be recognized. Most important, the operators were residents with "varying degrees of experience performing ultrasound examinations, from no documented experience to over 100 documented examinations." Thus, the investigators did not control for a critically important variable, operator skill level. Second, convenience sampling likely introduced selection bias prior to randomization. Third, this study is likely underpowered based on a power calculation using the mean difference in insertion attempts (-0.44) reported in the meta-analysis of 14 randomized trials by Shaikh et al.3 that found ultrasound guidance reduced the number of needle insertions, needle redirections, and failed procedures.

No formal cost-effectiveness studies have been published, but we can speculate that a higher success rate of lumbar puncture expedites patient care and reduce healthcare costs. Low- and middle-income countries are increasingly using point-of-care ultrasound because it is a relatively inexpensive, portable imaging modality that can be utilized by frontline clinicians as summarized by Sippel.4

Ultrasound guidance for lumbar puncture has shown the greatest benefit in patients with few palpable landmarks, most often due to obesity. Before attempting to use ultrasound in an obese patient, providers must have mastered the technique, and the only way to master a technique is to gain experience by practicing it routinely. We recommend that procedure educators continue to use ultrasound guidance to provide their trainees with the opportunity to learn a technique that requires practice to master. Rodriguez-Paz et al.5 eloquently summarizes how the training paradigm has shifted beyond "see one, do one, teach one" for patient safety.

Disclosures: N.J. Soni receives publishing royalties for Point-of-Care Ultrasound, 1st ed. (Elsevier-Saunders, 2014). D. Schnobrich, D.M. Tierney, G. Salame, and P. McHardy report no disclosures.

References

1. Soni NJ, Franco-Sadud R, Schnobrich D, et al. Ultrasound guidance for lumbar puncture. Neurol Clin Pract 2016;6:358-368.

2. Peterson MA, Pisupati D, Heyming TW, Abele JA, Lewis RJ. Ultrasound for routine lumbar puncture. Acad Emerg Med 2014;21:130-136.

3. Shaikh F, Brzezinski J, Alexander S, et al. Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta-analysis. BMJ 2013;346:f1720.

4. Sippel S, Muruganandan K, Levine A, Shah S. Review article: Use of ultrasound in the developing world. Int J Emerg Med 2011;4:72.

5. Rodriguez-Paz JM, Kennedy M, Salas E, et al. Beyond "see one, do one, teach one": toward a different training paradigm. Quality & safety in health care 2009;18:63-68.

Information & Authors

Information

Published In

Neurology® Clinical Practice
Volume 6Number 4August 2016
Pages: 358-368

Publication History

Received: December 25, 2015
Accepted: April 5, 2016
Published online: June 29, 2016
Published in print: August 2016

Permissions

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Disclosures

N.J. Soni receives publishing royalties for Point-of-Care Ultrasound, 1st ed. (Elsevier-Saunders, 2014). R. Franco-Sadud, D. Schnobrich, R. Dancel, D.M. Tierney, and G. Salame report no disclosures. M.I. Restrepo reports partial support of his time from award K23HL096054 from the National Heart, Lung, and Blood Institute. P. McHardy reports no disclosures. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

Study Funding

Partially supported by award K23HL096054 (MIR) from the National Heart, Lung, and Blood Institute.

Authors

Affiliations & Disclosures

Nilam J. Soni, MD, MSc
Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
Point-Of-Care Ultrasound, 1st ed., Elsevier-Saunders, 2014
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Ricardo Franco-Sadud, MD
Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Daniel Schnobrich, MD
Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Ria Dancel, MD
Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
David M. Tierney, MD
Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Gerard Salame, MD
Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Marcos I. Restrepo, MD, MSc
Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Dr. Restrepo is partially supported by award number K23HL096054 from the National Heart, Lung, and Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Paul McHardy, MD
Section of Hospital Medicine (NJS) and Section of Pulmonary and Critical Care Medicine (NJS, MIR), South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio; Section of Hospital Medicine/Division of General Internal Medicine (RF-S), Medical College of Wisconsin, Milwaukee; Division of General Internal Medicine (DS), University of Minnesota, Minneapolis; Division of General Medicine and Epidemiology (RD), University of North Carolina, Chapel Hill; Department of Medical Education (DMT), Abbott Northwestern Hospital, Minneapolis, MN; Division of Hospital Medicine (GS), University of Colorado/Denver Health Hospital; and Department of Anesthesia (PM), Sunnybrook Health Sciences Centre, Toronto, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
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Notes

Correspondence to: [email protected]
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

Author Contributions

N.J. Soni participated in the study conception and design, analysis and interpretation of the data, and drafting the manuscript for intellectual content. R. Franco-Sadud participated in the study conception and design, interpretation of data, and drafting the manuscript. D. Schnobrich participated in analysis and interpretation of the data and drafting the manuscript. R. Dancel participated in drafting the manuscript and figures. D.M. Tierney participated in analysis and interpretation of the data and drafting the manuscript. G. Salame participated in drafting the manuscript. M.I. Restrepo participated in analysis and interpretation of the data and drafting the manuscript. P. McHardy participated in drafting the manuscript and figures.

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