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Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits

[Le traitement symptomatique de la céphalée post-ponction durale augmente la durée du séjour hospitalier et les visites à la salle d’urgence]

Pamela Angle, MD FRCPC^*, Samuel Lap Tak Tang, Dorothy Thompson, MB FRCPC^* and John Paul Szalai, PhD^*

^* From the Sunnybrook & Women’s College Health Sciences Center; and
the University of Toronto School of Medicine, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Pamela Angle, Department of Anesthesiology, Women’s College Hospital Campus, Sunnybrook and Women’s College Health Sciences Center, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada. Phone: 416-323-6008; Fax: 416-323-6307; E-mail: pamela.angle{at}sw.ca

Purpose: This retrospective cohort study examined hospital length of stay (LOS) and emergency room (ER) visits in parturients diagnosed with postdural puncture headache (PDPH) following recognized dural puncture (DP). All cases were managed expectantly. Outcomes were compared with matched controls with uneventful labour epidurals.

Methods: After Ethics Committee approval, the hospital perinatal database was used to identify healthy parturients with recognized DP during labour epidural placement from 1996–2001. Women developing PDPH after expectant management were matched with women with uneventful epidurals and no evidence of PDPH, as well as by parity, delivery mode and admission date. All women delivered term singletons. The primary outcome was LOS (hours) from delivery to discharge. Secondary outcomes included: number (#) nights in hospital, #ER visits for PDPH, epidural blood patch (EBP) timing (pre vs post discharge), EBP location (ward vs ER) and blood volumes used.

Results: 26 cases and 26 controls were identified. Precise discharge times were found for 23 cases and 23 controls. In cases, the LOS was increased by a mean of 17 ± 23.8 (SD) hours; [95% conficence interval (CI) = 8, 26; P = 0.0012] and # nights in hospital was increased by a mean of 0.62 ± 0.94 nights (95% CI, 0.26, 0.98, P = 0.0027). Nineteen cases (73% 19/26) received at least one EBP. Sixteen cases received at least one EBP prior to discharge with 38% (6/16) returning to ER for re-assessment/repeat EBP. Forty-four percent (4/9) of cases without an EBP prior to discharge returned to ER for further assessment/EBP.

Conclusion: PDPH leads to a significant increase in hospital LOS and ER visits. Studies of preventive therapy are warranted.

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				P. J. Angle, K. Hussain, A. Morgan, S. H. Halpern, M. Van der Vyver, J. Yee, and A. Kiss High quality labour analgesia using small gauge epidural needles and catheters: [Une analgesie de qualite pendant le travail avec l'usage d'aiguilles et de catheters de petit calibre]. Can J Anesth, March 1, 2006; 53(3): 263 - 267. [Abstract] [Full Text] [PDF]