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Title: Development and validation of a predictive risk factor model for epidural re-siting in women undergoing labour epidural analgesia: A retrospective cohort study
Authors: Lee, J.S.E
Sultana, R
Han, N.L.R
Sia, A.T.H 
Sng, B.L 
Keywords: adult
cerebrospinal fluid examination
cohort analysis
controlled study
epidural analgesia
high risk pregnancy
labor pain
major clinical study
measurement accuracy
obstetric analgesia
predictive value
retrospective study
risk factor
vein puncture
adverse device effect
drug effect
epidural analgesia
indwelling catheter
labor pain
multivariate analysis
obstetric analgesia
predictive value
risk factor
Analgesia, Epidural
Analgesia, Obstetrical
Catheters, Indwelling
Cohort Studies
Labor Pain
Labor, Obstetric
Multivariate Analysis
Predictive Value of Tests
Reproducibility of Results
Retrospective Studies
Risk Factors
Issue Date: 2018
Citation: Lee, J.S.E, Sultana, R, Han, N.L.R, Sia, A.T.H, Sng, B.L (2018). Development and validation of a predictive risk factor model for epidural re-siting in women undergoing labour epidural analgesia: A retrospective cohort study. BMC Anesthesiology 18 (1) : 176. ScholarBank@NUS Repository.
Abstract: Background: Epidural catheter re-siting in parturients receiving labour epidural analgesia is distressing to the parturient and places them at increased complications from a repeat procedure. The aim of this study was to develop and validate a clinical risk factor model to predict the incidence of epidural catheter re-siting in labour analgesia. Methods: The data from parturients that received labour epidural analgesia in our centre during 2014-2015 was used to develop a predictive model for epidural catheter re-siting during labour analgesia. Multivariate logistic regression analysis was used to identify factors that were predictive of epidural catheter re-siting. The forward, backward and stepwise variable selection methods were applied to build a predictive model, which was internally validated. The final multivariate model was externally validated with the data collected from 10,170 parturients during 2012-2013 in our centre. Results: Ninety-three (0.88%) parturients in 2014-2015 required re-siting of their epidural catheter. The training data set included 7439 paturients in 2014-2015. A higher incidence of breakthrough pain (OR = 4.42), increasing age (OR = 1.07), an increased pain score post-epidural catheter insertion (OR = 1.35) and problems such as inability to obtain cerebrospinal fluid in combined spinal epidural technique (OR = 2.06) and venous puncture (OR = 1.70) were found to be significantly predictive of epidural catheter re-siting, while spontaneous onset of labour (OR = 0.31) was found to be protective. The predictive model was validated internally on a further 3189 paturients from the data of 2014-2015 and externally on 10,170 paturients from the data of 2012-2013. Predictive accuracy of the model based on C-statistic were 0.89 (0.86, 0.93) and 0.92 (0.88, 0.97) for training and internal validation data respectively. Similarly, predictive accuracy in terms of C-statistic was 0.89 (0.86, 0.92) based on 2012-2013 data. Conclusion: Our predictive model of epidural re-siting in parturients receiving labour epidural analgesia could provide timely identification of high-risk paturients required epidural re-siting. © 2018 The Author(s).
Source Title: BMC Anesthesiology
ISSN: 1471-2253
DOI: 10.1186/s12871-018-0638-x
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