Skip to main content
Log in

Comparison of underlying factors behind parental refusal or consent for lumbar puncture

  • Original article
  • Published:
World Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Background

Although lumbar puncture (LP) is a safe procedure in experienced hands, some parents fear having it performed on their children and refuse consent. The factors associated with this refusal are unclear, and any differences with consenting parents might provide clues as to how to address them. Therefore, we compared the underlying factors between the parents who refuse and those who consent to this procedure, as well as their children’s outcomes.

Methods

A prospective study of the two groups of parents was conducted by a face-to-face structured interview. Parents’ demographic factors, knowledge, perceptions, beliefs and attitudes, as well as their children’s outcomes, were compared. The odds ratio (OR) with 95% confidence intervals was calculated for significant associations.

Results

Consent was declined by 24 out of 55 families (44%). Alternative options were offered more often to those refusing consent (OR=5.7). Significantly more parents who refused consent also refused bladder catheterization (OR=18), knowing someone with complications following LP (OR=8.7), felt that it was not needed (OR=7.9) or that it induced complications (OR=12.5). A significantly higher proportion of the consenting parents were aware that meningitis might cause convulsions (OR=4.6), deafness or blindness (OR=2.9).

Conclusion

The differences in the understanding, perceptions, beliefs and fears between the parents who refused consent and those who agreed, can provide clues to the developing of appropriate strategies when requesting consent for LP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Ling SG, Boey CC. Lumbar puncture refusal in febrile convulsion. Singapore Med J 2000;41:485–488.

    PubMed  CAS  Google Scholar 

  2. Deng CT, Zulkifli HI, Azizi BH. Parents’ views of lumbar puncture in children with febrile seizures. Med J Malaysia 1994;49:263–268.

    PubMed  CAS  Google Scholar 

  3. Perneger TV, Chamot E, Bovier PA. Nonresponse bias in a survey of patient perceptions of hospital care. Med Care 2005;43:374–380.

    Article  PubMed  Google Scholar 

  4. Krause N. Stress, control beliefs, and psychological distress: the problem of response bias. J Human Stress 1985;11:11–19.

    Article  PubMed  CAS  Google Scholar 

  5. Cooke RW. Good practice in consent. Semin Fetal Neonatal Med 2005;10:63–71.

    Article  PubMed  Google Scholar 

  6. Diekema DS. Ethical issues in research involving infants. Semin Perinatol 2009;33:364–371.

    Article  PubMed  Google Scholar 

  7. Wilson S, Draper H, Ives J. Ethical issues regarding recruitment to research studies within the primary care consultation. Fam Pract 2008;25:456–461.

    Article  PubMed  Google Scholar 

  8. Manthous CA, DeGirolamo A, Haddad C, Moateng-Adjepong Y. Informed consent for medical procedures: local and national practices. Chest 2003;124:1978–1984.

    Article  PubMed  Google Scholar 

  9. Easton RB, Graber MA, Monnahan J, Hughes J. Defining the scope of implied consent in the emergency department. Am J Bioeth 2007;7:35–38.

    Article  PubMed  Google Scholar 

  10. Davis N, Pohlman A, Gehlbach B, Kress JP, McAtee J, Herlitz J, et al. Improving the process of informed consent in the critically ill. JAMA 2003;289:1963–1968.

    Article  PubMed  Google Scholar 

  11. Beresford HR. Informed consent before lumbar puncture. N Engl J Med 1980;303:1534.

    PubMed  CAS  Google Scholar 

  12. Botkin JR. Informed consent for lumbar puncture. Am J Dis Child 1989;143:899–904.

    PubMed  CAS  Google Scholar 

  13. Avner JR, Selbst SM. Informed consent for lumbar puncture: an alternative. Am J Dis Child 1990;144:272.

    Article  PubMed  CAS  Google Scholar 

  14. Habiba A. Parental attitude to lumbar puncture for children with fever and seizure. Pediatrics 2007;120:1220.

    Article  PubMed  Google Scholar 

  15. Rudinsky SL, Carstairs KL, Reardon JM, Simon LV, Riffenburgh RH, Tanen DA. Serious bacterial infections in febrile infants in the post-pneumococcal conjugate vaccine era. Acad Emerg Med 2009;16:585–590.

    Article  PubMed  Google Scholar 

  16. Waddle E, Jhaveri R. Outcomes of febrile children without localising signs after pneumococcal conjugate vaccine. Arch Dis Child 2009;94:144–147.

    Article  PubMed  CAS  Google Scholar 

  17. Offringa M, Beishuizen A, Derksen-Lubsen G, Lubsen J. Seizures and fever: can we rule out meningitis on clinical grounds alone? Clin Pediatr (Phila) 1992;31:514–522.

    Article  CAS  Google Scholar 

  18. Narchi H. Febrile convulsions: When is a lumbar puncture indicated? J Pediatr Neurol 2007;5:87–92.

    Google Scholar 

  19. Kimia AA, Capraro AJ, Hummel D, Johnston P, Harper MB. Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age. Pediatrics 2009;123:6–12.

    Article  PubMed  Google Scholar 

  20. Kimia A, Ben-Joseph EP, Rudloe T, Capraro A, Sarco D, Hummel D, et al. Yield of lumbar puncture among children who present with their first complex febrile seizure. Pediatrics 2010;126:62–69.

    Article  PubMed  Google Scholar 

  21. Durongpisitkul K, Gururaj VJ, Martin CF. The appropriateness of early discharge of hospitalized children with suspected sepsis. J Fam Pract 1997;44:91–96.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hassib Narchi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Narchi, H., Ghatasheh, G., Hassani, N.A. et al. Comparison of underlying factors behind parental refusal or consent for lumbar puncture. World J Pediatr 9, 336–341 (2013). https://doi.org/10.1007/s12519-013-0419-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-013-0419-z

Key words

Navigation