Chen Hung-Chieh, Hou Tsung-Wei, Chen Po-Lin, Wu Chih-Cheng, Wang Shuu-Jiun, Wang Yen-Feng
Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2025 Feb 1;88(2):138-144. doi: 10.1097/JCMA.0000000000001197. Epub 2024 Dec 12.
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 patients with SIH.
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.
Ninety-six patients (58 female [F]/38 male [M], mean age: 42.67 ± 10.16 years) were screened, with 49 (32 F/17 M, mean age: 41.20 ± 9.13 years) analyzed, including 30 (22 F/8 M, mean age: 41.10 ± 10.14 years) (61.2%) responders. 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 a score of <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 (Area under curve (AUC) = 0.77, p < 0.001) (sensitivity = 52.6%, specificity = 90.0%, accuracy = 75.5%).
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.
硬膜外血贴疗法（EBP）是自发性颅内低压（SIH）的主要治疗方法，尽管有时可能需要多次尝试。SIH-EBP评分，截断值≥3时，可预测对首次EBP的反应。然而，其普遍性需要进一步证实。本研究旨在验证SIH-EBP评分的临床实用性，并确定在独立的SIH患者队列中预测对首次EBP反应的最佳截断值。
这项回顾性研究纳入了在一家三级医疗中心接受至少一次EBP的SIH患者。从电子病历中提取临床数据，并回顾脑部和脊髓磁共振图像。
共筛选出96例患者（58例女性/38例男性，平均年龄：42.67±10.16岁），其中49例（32例女性/17例男性，平均年龄：41.20±9.13岁）进行分析，包括30例（22例女性/8例男性，平均年龄：41.10±10.14岁）（61.2%）有反应者。SIH-EBP评分与有反应率之间存在正相关（p = 0.001）。截断值≥3的评分与<3的评分相比，反应率更高（80.0%对41.7%，p = 0.006）（敏感性 = 73.7%，特异性 = 66.7%，准确性 = 69.4%）。该队列中的最佳截断值为≥2（曲线下面积（AUC） = 0.77，p < 0.001）（敏感性 = 52.6%，特异性 = 90.0%，准确性 = 75.5%）。
在该队列中，SIH-EBP评分与首次EBP的反应率相关。虽然评分≥3仍然是治疗反应的有效预测指标，但截断值≥2被证明更准确和特异。然而，其实际应用受到52.6%的敏感性的限制。需要进一步研究以验证其在其他人群中的作用。
