The SIH-EBP Score: A grading scale to predict the response to the first epidural blood patch in spontaneous intracranial hypotension. (March 2023)

• Record Type: Journal Article
• Authors: Lin, Po-Tso; Wang, Yen-Feng; Hseu, Shu-Shya; Fuh, Jong-Ling; Lirng, Jiing-Feng; Wu, Jr-Wei; Chen, Shu-Ting; Chen, Shih-Pin; Chen, Wei-Ta; Wang, Shuu-Jiun
• Is Part Of: Cephalalgia. Volume 43:Number 3(2023)
• Publication Date: 2023-03
• Subjects: Spontaneous intracranial hypotension -- epidural blood patch -- cerebrospinal fluid leakage -- SIH-EBP score -- heavily T2-weighted magnetic resonance myelography; Headache -- Periodicals; 616.8491
• DOI: 10.1177/03331024221147488
• Languages: English
• ISSNs: 0333-1024

Abstract

Background: To develop and validate an easy-to-use scoring system to predict the response to the first epidural blood patching in patients with spontaneous intracranial hypotension. Methods: This study recruited consecutive patients with spontaneous intracranial hypotension receiving epidural blood patching in a tertiary medical center, which were chronologically divided into a derivation cohort and a validation cohort. In the derivation cohort, factors associated with the first epidural blood patching response were identified by using multivariable logistic regression modeling. A scoring system was developed, and the cutoff score was determined by using the receiver operating characteristic curve. The findings were verified in an independent validation cohort. Results: The study involved 280 patients in the derivation cohort and 78 patients in the validation cohort. The spontaneous intracranial hypotension-epidural blood patching score (range 0–5) included two clinical variables (sex and age) and two radiological variables (midbrain-pons angle and anterior epidural cerebrospinal fluid collections). A score of ≥3 was predictive of the first epidural blood patching response, which was consistent in the validation cohort. Overall, patients who scored ≥3 were more likely to respond to the first epidural blood patching (odds ratio = 10.3). Conclusion: For patients with spontaneous intracranial hypotension-epidural blood patching score ≥3, it is prudent to attempt at least one targeted epidural blood patching before considering more invasive interventions.