SIH-EBP score for prediction of efficacy of epidural blood patching in an independent cohort of patients with spontaneous intracranial hypotension

Hung-Chieh Chen; Tsung-Wei Hou; Po-Lin Chen; Chih-Cheng Wu; Shuu-Jiun Wang; Yen-Feng Wang

doi:10.1097/JCMA.0000000000001197

SIH-EBP score for prediction of efficacy of epidural blood patching in an independent cohort of patients with spontaneous intracranial hypotension

J Chin Med Assoc. 2024 Dec 12. doi: 10.1097/JCMA.0000000000001197. Online ahead of print.

Authors

Hung-Chieh Chen^{1

2

3}, Tsung-Wei Hou⁴, Po-Lin Chen^{2

3

4}, Chih-Cheng Wu^{3

5

6

7}, Shuu-Jiun Wang^{2

8

9}, Yen-Feng Wang^{2

8

9}

Affiliations

¹ Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
² College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
³ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University Taichung, Taiwan, ROC.
⁴ Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
⁵ Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
⁶ Department of Financial Engineering, Providence University, Taichung, Taiwan, ROC.
⁷ Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan, ROC.
⁸ Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
⁹ Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.

PMID: 39663587
DOI: 10.1097/JCMA.0000000000001197

Abstract

Background: Epidural blood patching (EBP) is the primary treatment for spontaneous intracranial hypotension (SIH), although multiple attempts may sometimes be necessary. The SIH-EBP score, with a cutoff of ≥3, predicts the response to the first EBP. However, its generalizability requires further confirmation. This study aims to validate the clinical utility of the SIH-EBP score and determine the optimal cutoff for predicting the response to the first EBP in an independent cohort of SIH patients.

Methods: This retrospective study included patients with SIH who received at least one EBP at a tertiary medical center. Clinical data were extracted from electronic medical records, and brain and spinal magnetic resonance images were reviewed.

Results: Ninety-six patients (58F/38M, mean age 42.67 ± 10.16 years) were screened, with 49 analyzed (32F/17M, mean age 41.20 ± 9.13 years), including 30 responders (22F/8M, mean age 41.10 ± 10.14 years) (61.2%). There was a positive correlation between SIH-EBP scores and responder rates (p=0.001). A cutoff score of ≥3 was associated with a higher response rate than <3 (80.0% vs. 41.7%, p=0.006) (sensitivity=73.7%, specificity=66.7%, accuracy=69.4%). The optimal cutoff in this cohort was ≥2 (AUC=0.77, p<0.0001) (sensitivity=52.6%, specificity=90.0%, accuracy=75.5%).

Conclusion: In this cohort, the SIH-EBP score correlated with response rates to the first EBP. Although a score of ≥3 remains a valid predictor of treatment response, a cutoff of ≥2 proved to be more accurate and specific. However, its practical use is limited by a sensitivity of 52.6%. Further studies are needed to verify its role in other populations.