Introduction: Intrathecal baclofen (ITB) is an effective chronic therapy for patients with spasticity and dystonia. Intrathecal administration is advantageous over enteral medication because ITB has limited systemic absorption and greater potency. However, issues with the ITB pump can arise following surgical procedures, particularly near the spine. If catheter flow is inadvertently disrupted during surgery, drug delivery may be interrupted and cause ITB withdrawal syndrome, a potentially life-threatening complication. Early recognition can be challenging because the clinical presentation of abrupt ITB withdrawal mimics common post-operative symptoms. ITB withdrawal can also mimic malignant hyperthermia or sepsis, not uncommon problems in this population. No tool currently exists to screen for ITB withdrawal in patients and there is a need to improve the detection of ITB withdrawal in complex patients, especially after surgery. Our objective was to create and test a tool to detect ITB withdrawal that is convenient and usable for a broad range of clinicians with no prior experience with the diagnosis of ITB withdrawal.
Methods: We consulted the literature and clinicians with expertise in ITB withdrawal syndrome and developed a scorecard that includes the major signs of ITB withdrawal.
Results: With IRB approval, we tested the scorecard on a retrospective cohort of 33 children with increased risk of ITB withdrawal. The median age was 14 years (range 8-21), and three (9.1%) had confirmed ITB withdrawal. The pilot scorecard had 100% sensitivity, 82% specificity, 33% positive predictive value, and 100% negative predictive value.
Conclusions: The ITB Withdrawal Scorecard is an easy-to-use screening tool that may improve detection of ITB withdrawal, especially when used by providers with minimal experience with diagnosing this potentially serious condition. Our goal was to develop a tool to trigger a consult from experienced ITB providers, and we demonstrated feasibility. Validation in a prospective multicenter cohort is needed.
Patient Care: ITB withdrawal syndrome is relatively rare and many clinicians may not appreciate the need for early suspicion and treatment of ITB withdrawal. The goal of the scorecard is to trigger timely evaluation for possible ITB withdrawal.
Learning Objectives: By the conclusion of this session participants should be able to 1) List symptoms and signs of ITB withdrawal, 2) Recognize the clinical challenge of diagnosing ITB withdrawal in the context of other common clinical scenarios in this population, 3) recognize the need to promptly involve experienced providers in the management of patients with ITB withdrawal.