- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05824546
uSINE-PAMS Artificial Intelligence Driven, Ultrasound-Guided Lumbar Puncture to Improve Procedural Accuracy
Study Overview
Status
Conditions
Detailed Description
Lumbar puncture (LP) is a routine invasive procedure performed for the diagnosis and treatment of central nervous system disorders. The traditional landmark-based method is associated with a high failure rate of up to 50%, leading to complications including back pain and epidural hematoma, diagnostic delay, and increased healthcare costs. The success rate has been improved with ultrasound guided LP but the use of ultrasound-guided LP has not been widespread due to inadequate training in ultrasound use and the inability to translate information derived from ultrasonography to the LP procedure. uSINE-PAMS was designed to address these challenges: uSINE is a machine-learning software to aid the operators in ultrasound-guided LP; PAMS is a two-part hardware to translate data from ultrasound to accurate needle insertion and angulation.
This study consists of a pilot phase to test the usability of uSINE-PAMs and allow for improvement in technology and clinical workflow for uSINE-PAMS. In the pilot phase, experienced NNI clinicians who have participated in a previous healthy volunteer study and have been trained to use uSINE will be the operators performing the uSINE-PAMS-guided lumbar puncture. During and upon completion of the study, challenges in the use of uSINE and PAMS to conduct LP as well as in the implementation of uSINE-PAMS in the clinical workflow will be determined and addressed prior to the main study, a randomized controlled trial. Ten patients will be recruited in this pilot phase.
Following the pilot phase, the main study (randomized controlled trial) will be conducted to evaluate the effectiveness of uSINE-PAMS-guided lumbar puncture. 100 patients will be randomized to undergo LP using uSINE-PAMS guided technique or traditional landmark-based method. The investigators hypothesize that uSINE-PAMS guided lumbar puncture will achieve at least 20% improvement in first pass success rate of obtaining cerebrospinal fluid compared to traditional landmark-based technique, therefore leading to reduction in complication rates.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Xuling Lin, MBBS
- Phone Number: 63577153
- Email: lin.xu.ling@singhealth.com.sg
Study Locations
-
-
-
Singapore, Singapore
- Recruiting
- National Neuroscience Institute (NNI)
-
Contact:
- Xuling Lin, MBBS
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
INCLUSION CRITERIA:
- Patients planned for lumbar puncture as part of their clinical care
- 21 years of age or older
- Able to provide informed consent
EXCLUSION CRITERIA:
- Allergy to ultrasound gel
- Previous lumbar spinal instrumentation
- Patients with suspected spinal epidural abscess or any other infection at the potential site of needle entry on the back
- Possible raised intracranial pressure with risk of cerebral herniation, including presence of obstructive hydrocephalus, intracranial space-occupying lesion and cerebral edema
- Presence of significant thrombocytopenia (platelet <100k) or other bleeding diathesis; patients on antiplatelet and/or anticoagulation may be included if their antiplatelet and/or anticoagulation can be and are stopped for an adequate duration prior to lumbar puncture according to the institution guidelines.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Intervention Arm
Patients will undergo LP using uSINE-PAMS-guided technique
|
Patients will be lying in a lateral recumbent position and in a fetal position with the neck, back and limbs held in flexion.
L3-L4 inter-vertebral space will be identified by palpation of external landmarks of the patients' iliac crests and spinous process of lumbar vertebrae L3, L4 and L5 and confirmed using uSINE-integrated ultrasound.
The angle of needle during needle advancement will also be determined using the uSINE-integrated ultrasound.
Markings on the patients' skin surface will be made using PAMS (non-sterile component) to enable relocation of the site and angle of the needle entry.
Patients' back will be cleaned and draped using aseptic technique.
Next, local anaesthesia is infiltrated into the previously identified needle entry site before the LP needle is inserted with location and angulation according to PAMS (sterile component) guidance.
|
Active Comparator: Control Arm
Patients will undergo LP using traditional landmark-based method
|
Patients will be lying in a lateral recumbent position and in a fetal position with the neck, back and limbs held in flexion.
L3-L4 inter-vertebral space will be similarly identified by palpation of external landmarks of iliac crests and spinous process of lumbar vertebrae L3, L4 and L5.
Markings on the patients' skin surface will be made with a washable marker or any other methods according to the operator's preference to enable relocation of the site of the needle entry.
Patients' back will be cleaned and draped using aseptic technique.
Next, local anaesthesia is infiltrated into the previously identified needle entry site before the LP needle is inserted into marked entry site.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
To compare the first pass success rate of obtaining cerebrospinal fluid using uSINE-PAMS-guided technique against the traditional landmark-based method
Time Frame: During procedure
|
First pass is defined as the first LP attempt without withdrawing the LP needle out of the skin.
|
During procedure
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
To compare the number of needle redirections using uSINE-PAMS-guided technique with that using the traditional landmark-based method
Time Frame: During procedure
|
Needle redirection is defined as the number of times the LP needle was repositioned to obtain the CSF without withdrawing out of the skin.
|
During procedure
|
To compare the rate of traumatic LP using uSINE-PAMS-guided technique against the traditional landmark-based method
Time Frame: 1 hour after procedure
|
Traumatic LP is defined as needle-induced blood (>5 red blood cells/ul) in the cerebrospinal fluid; Cases where red blood cells are expected in the cerebrospinal fluid will be excluded from this analysis.
|
1 hour after procedure
|
To compare the pain score from LP using uSINE-PAMS-guided technique with that from LP using the traditional landmark-based method
Time Frame: Immediately after procedure
|
Pain score will be assessed using the Universal Pain Assessment Tool which has a scale of 0-10.
|
Immediately after procedure
|
To compare the rate of back pain that develops within 24 hours of the LP using uSINE-PAMS-guided technique with the traditional landmark-based method
Time Frame: Approximately 24 hours after procedure
|
Pain score will be assessed using the Universal Pain Assessment Tool which has a scale of 0-10.
|
Approximately 24 hours after procedure
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
To compare the rate of serious complications from LP using uSINE-PAMS-guided technique with that from LP using the traditional landmark-based method
Time Frame: Within 1 week of procedure
|
Serious complications include spinal hematoma, subdural hematoma, central nervous system infection and headaches requiring hospitalizations
|
Within 1 week of procedure
|
Collaborators and Investigators
Sponsor
Collaborators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- uSINE
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Ultrasound Therapy
-
UltraSightCompleted
-
Assiut UniversityRecruitingUltrasound Therapy; ComplicationsEgypt
-
National Cancer Institute, EgyptCompletedUltrasound Therapy; ComplicationsEgypt
-
Ataturk UniversityCompletedUltrasound Therapy; ComplicationsTurkey
-
Tongji HospitalNot yet recruitingUltrasound Therapy; Complications
-
Rongqin ZhengNot yet recruiting
-
National Taiwan University HospitalCompletedUltrasound Therapy; ComplicationsTaiwan
-
Omer KaracaBaskent UniversityCompletedUltrasound Therapy; ComplicationsTurkey
-
Assiut UniversityNot yet recruitingUltrasound Therapy; Complications
-
Cairo UniversityNot yet recruitingUltrasound Therapy; Complications
Clinical Trials on Intervention Arm (uSINE-PAMS technique):
-
Riphah International UniversityCompletedAdhesive CapsulitisPakistan
-
Riphah International UniversityRecruitingAdhesive CapsulitisPakistan
-
Government Medical College KottayamCompletedCoronary Artery Disease | Coronary Artery Disease With Myocardial InfarctionIndia
-
UConn HealthNational Heart, Lung, and Blood Institute (NHLBI)Completed
-
Centre Leon BerardNational Cancer Institute, France; Fondation de France; Cancéropôle Lyon Auvergne... and other collaboratorsCompletedImpact of Nutritional Intervention in Women With Breast Cancer Under Adjuvant Chemotherapy (PASAPAS)Breast Cancer | Adequate Physical ConditionFrance
-
Jonsson Comprehensive Cancer CenterAmerican Cancer Society, Inc.Completed
-
Sahreen AnwarRecruiting
-
Heart of England NHS TrustAstraZenecaUnknown
-
Gia MuddNational Institute of Nursing Research (NINR); National Institutes of Health...CompletedCardiovascular Diseases | Diabetes Mellitus, Type 2 | Risk Reduction BehaviorUnited States
-
Lawson Health Research InstituteCompletedChronic Kidney DiseaseCanada