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- Title
Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group: A Summary Report.
- Authors
Uppal, Vishal; Russell, Robin; Sondekoppam, Rakesh; Ansari, Jessica; Baber, Zafeer; Chen, Yian; DelPizzo, Kathryn; Dîrzu, Dan Sebastian; Kalagara, Hari; Kissoon, Narayan R.; Kranz, Peter G.; Leffert, Lisa; Lim, Grace; Lobo, Clara A.; Lucas, Dominique Nuala; Moka, Eleni; Rodriguez, Stephen E.; Sehmbi, Herman; Vallejo, Manuel C.; Volk, Thomas
- Abstract
This consensus statement describes the process of creating evidence-based guidelines for postdural puncture headache that considered risk factors, preventive measures, and therapies and their adverse effects. Key Points: Question: To improve care and enhance patient safety, how should clinicians attempt to prevent, diagnose, and manage postdural puncture headache (PDPH)? Findings: In this consensus statement, a multidisciplinary panel of 21 collaborators outlined recommendations for the prevention, identification, and management of PDPH. The strength and certainty of evidence of various patient, procedural, diagnostic, and management aspects of PDPH were graded. Meaning: These practice guidelines provide a framework for individual clinicians to assess risk, confirm diagnosis, and adopt a systematic approach to management of PDPH. Importance: Postdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures, such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis, and management of this condition is, however, currently lacking. Objective: To fill the practice guidelines void and provide comprehensive information and patient-centric recommendations for preventing, diagnosing, and managing PDPH. Evidence Review: With input from committee members and stakeholders of 6 participating professional societies, 10 review questions that were deemed important for the prevention, diagnosis, and management of PDPH were developed. A literature search for each question was performed in MEDLINE on March 2, 2022. Additional relevant clinical trials, systematic reviews, and research studies published through March 2022 were also considered for practice guideline development and shared with collaborator groups. Each group submitted a structured narrative review along with recommendations that were rated according to the US Preventive Services Task Force grading of evidence. Collaborators were asked to vote anonymously on each recommendation using 2 rounds of a modified Delphi approach. Findings: After 2 rounds of electronic voting by a 21-member multidisciplinary collaborator team, 47 recommendations were generated to provide guidance on the risk factors for and the prevention, diagnosis, and management of PDPH, along with ratings for the strength and certainty of evidence. A 90% to 100% consensus was obtained for almost all recommendations. Several recommendations were rated as having moderate to low certainty. Opportunities for future research were identified. Conclusions and Relevance: Results of this consensus statement suggest that current approaches to the treatment and management of PDPH are not uniform due to the paucity of evidence. The practice guidelines, however, provide a framework for individual clinicians to assess PDPH risk, confirm the diagnosis, and adopt a systematic approach to its management.
- Subjects
HEADACHE diagnosis; HEADACHE treatment; CONSENSUS (Social sciences); PATIENT-centered care; MEDICAL protocols; HUMAN services programs; LUMBAR puncture; MENINGES; INTERPROFESSIONAL relations; U.S. Preventive Services Task Force; INTERNATIONAL agencies; HEADACHE; PROFESSIONAL associations
- Publication
JAMA Network Open, 2023, Vol 6, Issue 8, pe2325387
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.25387