Abstract

We read with interest the report of the Therapeutics and Technology Assessment (TTA) Subcommittee of the AAN providing an addendum to the assessment on the prevention of post-lumbar puncture headaches (PLPHAs) following diagnostic LPs.1 We were surprised that a consensus was reached for a Level A recommendation. Only one Class I article was cited.2 In the Strupp et al. study, 306 patients were allocated randomly to the “atraumatic” vs “traumatic” needle, yet 230 are evaluated, representing a drop-out rate of 25%. Of the 76 drop-outs, 25 did not return the evaluation sheet. Since the Subcommittee's recommendation includes a mandate to enact widespread educational strategies to impact neurologic practice, we think an intention-to-treat analysis that incorporates all randomized patients would be important. When further assessing the Strupp et al. article,2 the control event rate of 24% vs experimental event rate of 12% translates to a relative risk reduction of 50% and absolute risk reduction …

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