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Examining the evidence in anesthesia literature: a survey and evaluation of obstetrical postdural puncture headache reports

[Examen de la preuve dans la documentation sur l'anesthésie : enquête et évaluation des articles sur les céphalées obstétricales post-ponction durale]

Peter T.-L. Choi, MD FRCPC MSc^*,, Saramin E. Galinski, MHSc MD, Stefan Lucas, MD, Lawrence Takeuchi, MSc MD FRCPC^* and Alejandro R. Jadad, MD DPhil FRCPC

^* From the Department of Anesthesia, St. Joseph's Healthcare and
McMaster University,
Hamilton, Ontario, Canada; the Departments of Anesthesia and Health Administration, University Health Network, University of Toronto,
Toronto, Ontario, Canada; and the Department of Anesthesia, University of Rochester, Rochester, New York, USA.

Address correspondence to: Dr. Peter T.-L. Choi, Department of Anesthesia, McMaster University, 1200 Main Street West, Room HSC-2U5, Hamilton, Ontario L8N 3Z5, Canada. Phone: 905-521-2100 ext. 75174; Fax: 905-523-1224; E-mail: choip{at}mcmaster.ca

Purpose: To describe a bibliographic database on the literature of postdural puncture headache (PDPH) in the obstetrical population, to describe the research architecture in this field, and to evaluate the quality of case-control studies, cohort studies, and controlled clinical trials on PDPH.

Methods: Computerized bibliographic searches, citation review, and hand searches were conducted to find all relevant citations on incidence, clinical course, prevention, or treatment of PDPH in parturients. The study design and topic(s) covered by each study were evaluated. Case-control studies and cohort studies were evaluated using the Quality Index; clinical trials were evaluated using the Jadad scale.

Results: One hundred ninety-six relevant citations were published between 1949 and 1999. Research on PDPH has been increasing rapidly with the majority of studies published in the 1990's. Incidence and prevention were the focus of over half of all citations. Optimal study designs were infrequently utilized. The methodological quality was poor for observational studies (Quality Index 10/29) and clinical trials (Jadad scale 2/5).

Conclusion: Although the amount of research on PDPH in parturients is increasing, use of optimal study designs and improvement in methodology is needed.

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