Background: Epidural catheter re-siting in parturients receiving labour epidural analgesia is distressing to the\nparturient and places them at increased complications from a repeat procedure. The aim of this study was to\ndevelop and validate a clinical risk factor model to predict the incidence of epidural catheter re-siting in labour\nanalgesia.\nMethods: The data from parturients that received labour epidural analgesia in our centre during 2014â??2015 was\nused to develop a predictive model for epidural catheter re-siting during labour analgesia. Multivariate logistic\nregression analysis was used to identify factors that were predictive of epidural catheter re-siting. The forward,\nbackward and stepwise variable selection methods were applied to build a predictive model, which was internally\nvalidated. The final multivariate model was externally validated with the data collected from 10,170 parturients\nduring 2012â??2013 in our centre.\nResults: Ninety-three (0.88%) parturients in 2014â??2015 required re-siting of their epidural catheter. The training\ndata set included 7439 paturients in 2014â??2015. A higher incidence of breakthrough pain (OR = 4.42), increasing\nage (OR = 1.07), an increased pain score post-epidural catheter insertion (OR = 1.35) and problems such as\ninability to obtain cerebrospinal fluid in combined spinal epidural technique (OR = 2.06) and venous puncture\n(OR = 1.70) were found to be significantly predictive of epidural catheter re-siting, while spontaneous onset of\nlabour (OR = 0.31) was found to be protective. The predictive model was validated internally on a further 3189\npaturients from the data of 2014â??2015 and externally on 10,170 paturients from the data of 2012â??2013. Predictive\naccuracy 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\nvalidation data respectively. Similarly, predictive accuracy in terms of C-statistic was 0.89 (0.86, 0.92) based on\n2012â??2013 data.\nConclusion: Our predictive model of epidural re-siting in parturients receiving labour epidural analgesia could\nprovide timely identification of high-risk paturients required epidural re-siting.
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