Abstract ID: A13
Abstract Title: Gender and Postdural Puncture Headache: a Meta-analysis
Poster Type: Either
ABSTRACT BODY
Introduction:
Whether gender is an independent risk factor for the development of postdural puncture headache (PDPH) is controversial. Earlier studies indicated that females may have had a higher incidence of PDPH; however, more recent data suggest that there may be no significant difference in the incidence of PDPH between males and females. Because of some of the inconsistencies in the available data, we preformed a meta-analysis of randomized trials to determine the effect of gender on PDPH.
Materials and Methods:
The National Library of Medicine's PubMed database was searched for the time period 1966 to August 31, 2004 for textwords related to postdural puncture headache, neuraxial anesthesia, and lumbar puncture. To be included in this meta-analysis, the postural component of PDPH needed to be clearly indicated in the manuscript. Other inclusion criteria included trials that were randomized, evaluated only adult patients, and the incidence of PDPH studied and data available for both genders. Data recorded included study characteristics, type and size of lumbar puncture needle, number and mean age of males and females subjects, and incidence of PDPH. PDPH data were weighted by sample size. The overall incidence of PDPH (weighted for patient observations) after lumbar puncture between male and female subjects were compared. The data for incidence of PDPH was subdivided by needle type (e.g., cutting versus pencil-point), needle size, and age.
Results:
After limiting this search to the English language and then to human subjects, our search resulted in 306 abstracts, the full article of each which was then reviewed. A total of 19 trials (2253 males, 1935 females) meeting all inclusion criteria. The overall incidence of PDPH was significantly lower for males [11.7% (95% CI: 11.1-12.4%)] than females [21.2% (95% CI: 20.6-22.8%)] even though female subjects overall were significantly older (42.0 ± 7.0 vs. 38.8 ± 9.8, p < 0.001) and received a significantly higher percentage of pencil-point spinal needles (37.6% vs. 29.2%, p < 0.001) than male subjects, although they did receive a significantly larger percentage of larger gauge spinal needles than male subjects.
Discussion:
Analyzing only data from randomized controlled trials, we found that females subjects appear to have a higher incidence of PDPH than males although the etiology behind these findings is not clear from our meta-analysis.
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A13