Lost in Translation: Limited English Proficiency and Suboptimal Management of Postdural Puncture Headache 

Meeseo Lee BA, Stella M Alphas BA, Heidi C. Lightfoot MBBS MRes, Nolan Wheeler BS, Ricardo Kleinlein PhD, Vesela P. Kovacheva MD PhD, Jimin J. Kim MD MSc 

Background 

Epidemiology

Incidence: 0.4-1.5% 

Associated with significant maternal morbidity and interferes with maternal-infant bonding

Treatment 

Conservative measures 

Definitive treatment

Epidural blood patch (EBP) 

Barriers 

Racial and ethnic minority obstetric patients are less likely to receive EBP for postdural puncture headache (PDPH) 

Aim 

Determine whether obstetric patients with limited English proficiency (LEP) experience differences in PDPH management compared with non-LEP patients 

References 

Vallejo & Zakowski. Best Pract Res Clin Anaesthesiol. 2022. 

Armstrong S et al. Curr Opin Anaesthesiol. 2024. 

Lee A et al. JAMA Netw Open. 2022. 

Potnuru PP et al. Anesth Analg. 2024.  

 

Methods

Exposure

Preferred language as indicated by EHR

Non-LEP: English

LEP: non-English

Primary outcome

Receipt of EBP 

Secondary Outcomes

Time (hours) from neuraxial procedure to first EBP

Duration (days) of and number (n) of anesthesia follow-up

Repeat EBP (≥ 2)

 

Results 

Total of 556 obstetric patients with PDPH 

Non-LEP (n=500) 

LEP (n=56)

Compared to non-LEP, LEP patients had… 

70% lower odds of receiving EBP 

shorter and less anesthesia follow-up care 

 

Conclusion & Discussion

Obstetrics patients with limited English proficiency received suboptimal management for PDPH

Limitations include EHR inaccuracies,incompletediagnosticcapture, and residualconfounding

Targeted interventions to improve language-concordant care and standardized PDPH pathways are needed