背景:硬脑膜穿刺后头痛(PDPH)可以在硬膜外技术期间的无意硬脑膜穿刺或在诸如腰椎穿刺或脊髓麻醉的神经轴手术期间的有意硬脑膜穿刺之后。关于预防的循证指导,这种情况的诊断或治疗是,然而,目前缺乏。这份多社会指南旨在填补这一空白,并为从业者提供全面的信息和以患者为中心的建议,诊断和管理PDPH患者。
方法:根据委员会成员和利益相关者的意见,委员会联合主席提出了10个被认为对预防很重要的审查问题,PDPH的诊断和管理。每个问题的文献检索于2022年3月2日在MEDLINE(Ovid)中进行。每次搜索的结果都输入到单独的Covidence项目中进行重复数据删除和筛选,其次是数据提取。其他相关临床试验,还考虑了截至2022年3月发表的系统综述和研究研究,以制定指南,并与撰稿人分享.每个小组都提交了结构化的叙述性审查,并根据美国预防服务工作组的证据分级进行了分级。临时草案以电子方式分享,每个合作者都要求使用两轮修改后的Delphi方法对每个建议进行匿名投票。
结果:基于当代证据和共识,多学科小组提出了50条建议,以提供有关风险因素的指导,预防,PDPH的诊断和管理,以及他们的力量和证据的确定性。经过两轮投票,我们就所有声明和建议达成了高度共识。几项建议的证据确定性为中低。
结论:这些PDPH的临床实践指南提供了一个框架来改善鉴别,由执行神经轴手术的医生评估和提供循证护理,以提高护理质量并符合患者的兴趣。由于缺乏证据,PDPH的大多数管理方法的最佳实践仍然存在不确定性。此外,确定了未来研究的机会。
BACKGROUND: 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 or management of this condition is, however, currently lacking. This multisociety guidance aims to fill this void and provide practitioners with comprehensive information and patient-centric recommendations to prevent, diagnose and manage patients with PDPH.
METHODS: Based on input from committee members and stakeholders, the committee cochairs developed 10 review questions deemed important for the prevention, diagnosis and management of PDPH. A literature search for each question was performed in MEDLINE (Ovid) on 2 March 2022. The results from each search were imported into separate Covidence projects for deduplication and screening, followed by data extraction. Additional relevant clinical trials, systematic reviews and research studies published through March 2022 were also considered for the development of
guidelines and shared with contributors. Each group submitted a structured narrative review along with recommendations graded according to the US Preventative Services Task Force grading of evidence. The interim draft was shared electronically, with each collaborator requested to vote anonymously on each recommendation using two rounds of a modified Delphi approach.
RESULTS: Based on contemporary evidence and
consensus, the multidisciplinary panel generated 50 recommendations to provide guidance regarding risk factors, prevention, diagnosis and management of PDPH, along with their strength and certainty of evidence. After two rounds of voting, we achieved a high level of
consensus for all statements and recommendations. Several recommendations had moderate-to-low certainty of evidence.
CONCLUSIONS: These clinical practice
guidelines for PDPH provide a framework to improve identification, evaluation and delivery of evidence-based care by physicians performing neuraxial procedures to improve the quality of care and align with patients\' interests. Uncertainty remains regarding best practice for the majority of management approaches for PDPH due to the paucity of evidence. Additionally, opportunities for future research are identified.