Authors: Iteke R.F, Kitungwa K.O, Munkana N.A, Mulewa D.U, Mukuku O.K, Iragi D.M, Muyumba K.E, Brichant J.F, Kilembe A.M, Brouh Y, Kakoma S.Z.
Background: Post-spinal anesthesia headaches remain a problem in the world. The objective of this work was to evaluate their epidemiological and clinical characteristics, their determinants as well as the elaboration of an adapted predictive score in obstetric medium of resource-limited countries.
Methods: This was a descriptive and analytical observational study of 546 patients for 7 months in 6 hospitals in DR Congo. After multivariate analysis, the logistic regression was used to develop the predictive score with discrimination assessed using the ROC curve and calibration using the Hosmer-Lemeshow test.
Results: The prevalence was 27.5%. Significant determinants were: history of spinal anesthesia, L2-L3 puncture level, puncture attempts> 3, needle diameter <25 gauge, overweight, low operator level, age> 35 years, parity 1 and> 5, Quincke's needle as well as urgent interventions. Eight significant parameters rated from 1 to 2 resulted in a total score of 10 (<6 low risk, 6-7 moderate risk, and ≥ 8 high risk). The area under the ROC curve was 0.90 with a sensitivity of 66%, a specificity of 90.6%, a VPN of 87.3%, and a PPV of 72.8%.
Conclusion: The determinants of these headaches specific to our environment have been identified and have made it possible to develop a simple and reproducible predictive score that could allow screening, diagnostic orientation and even prophylactic treatment.
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