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


CONCLUSIONS
Although the amount of research on PDPH in parturients is increasing, use of optimal study designs and improvement in methodology is needed.
Choi
Peter T-L
PT
Department of Anesthesia, St. Joseph's Healthcare, Hamilton, Ontario, Canada. choip@mcmaster.ca
Galinski
Saramin E
SE
Lucas
Stefan
S
Takeuchi
Lawrence
L
Jadad
Alejandro R
AR
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D019985:Benchmarking; D016022:Case-Control Studies; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D016206:Databases, Bibliographic; D019317:Evidence-Based Medicine; D005260:Female; D006261:Headache / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012107:Research Design