title: Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  PDPH leads to a significant increase in hospital LOS and ER visits. Studies of preventive therapy are warranted.
authors.affiliation: Department of Anesthesiology, Women's College Hospital Campus, Sunnybrook and Women's College Health Sciences Center, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada. pamela.angle@sw.ca
authors.forename: Pamela
authors.initials: P
authors.lastname: Angle
authors.forename: Samuel Lap Tak
authors.initials: SL
authors.lastname: Tang
authors.forename: Dorothy
authors.initials: D
authors.lastname: Thompson
authors.forename: John Paul
authors.initials: JP
authors.lastname: Szalai
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D017217:Blood Patch, Epidural; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006261:Headache / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D011247:Pregnancy; D012189:Retrospective Studies