Utility of Combining Frailty and Comorbid Disease Indices to Better Predict Outcomes Following Craniotomy for Pediatric Primary Brain Tumors.

IF 1.3 4区医学 Q4 CLINICAL NEUROLOGY

Pediatric Neurosurgery Pub Date : 2025-10-03 DOI:10.1159/000548771

Alan Nguyen, Michelot Michel, Shane Shahrestani, Andre Boyke, Catherine M Garcia, Simon Menaker, Moise Danielpour, David Bonda

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引用次数: 0

Abstract

Objective: There are no predictive outcome scales that have been validated in pediatric patients with brain tumors. An index can help identify children with increased risk for negative postoperative results. The Johns Hopkins Adjusted Clinical Groups (JHACG) frailty and the Elixhauser Comorbidity Index (ECI) have been used independently in adult brain tumor patients to identify patients at increased risk for detrimental outcomes. We investigated whether JHACG and ECI can better predict hospital length of stay (LOS), non-routine discharge, and one-year readmission in pediatric patients undergoing craniotomy for primary brain tumors.

Methods: The Nationwide Readmissions Database (NRD) was queried for pediatric brain tumor resections between 2016 and 2019. 237 and 1,235 patients with benign and malignant tumors were identified, respectively. Frailty, ECI, and Frailty+ECI were assessed as predictors using generalized linear mixed-effects models. Receiver operating characteristic (ROC) curves evaluated predictive performance.

Results: Frailty+ECI, Frailty, and ECI scores similarly predicted hospital LOS, non-routine discharge, and one-year readmission in the benign tumor cohort. In the malignant cohort, Frailty+ECI (AUC 0.895) outperformed Frailty alone (AUC 0.742, p = 0.001) but performed similarly to ECI score alone (AUC 0.893, p = 0.438) in predicting hospital LOS. Concerning non-routine discharge prediction, Frailty+ECI (AUC 0.871) also outperformed Frailty alone (AUC 0.744, p = 0.04) while performing similarly to ECI score alone (AUC 0.869, p = 0.871). All indices performed similarly to predict one-year readmission in this cohort.

Conclusion: Our study demonstrated that Frailty+ECI demonstrated a robust ability to predict hospital LOS and non-routine discharge disposition in pediatric patients undergoing malignant brain tumor resection. These findings suggest that combining these indices may improve the prediction of postoperative outcomes in this population. While further studies are warranted, these findings can be used as a risk assessment index to coordinate care plans with the patient and their family after an operation.

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结合虚弱和合并症指标更好地预测小儿原发性脑肿瘤开颅后预后的应用

目的：目前尚无预测脑肿瘤患儿预后的量表。一个指数可以帮助识别术后阴性结果风险增加的儿童。约翰霍普金斯调整临床组（JHACG）虚弱和Elixhauser共病指数（ECI）已被独立用于成年脑肿瘤患者，以识别有害结果风险增加的患者。我们研究了JHACG和ECI是否能更好地预测原发性脑肿瘤开颅手术儿童患者的住院时间（LOS）、非常规出院和一年再入院。方法：查询全国再入院数据库（NRD）中2016年至2019年的儿童脑肿瘤切除术。良性肿瘤237例，恶性肿瘤1235例。使用广义线性混合效应模型评估虚弱、ECI和虚弱+ECI作为预测因子。受试者工作特征（ROC）曲线评估预测效果。结果：在良性肿瘤队列中，虚弱+ECI、虚弱和ECI评分类似地预测了医院LOS、非常规出院和一年再入院。在恶性队列中，虚弱+ECI评分（AUC 0.895）优于虚弱单独评分（AUC 0.742, p = 0.001），但在预测医院LOS方面与ECI评分单独评分（AUC 0.893, p = 0.438）相似。在非常规出院预测方面，fraty +ECI （AUC 0.871）也优于fraty单独评分（AUC 0.744, p = 0.04），而与ECI单独评分相似（AUC 0.869, p = 0.871）。在该队列中，预测1年再入院的所有指标表现相似。结论：我们的研究表明，在恶性脑肿瘤切除术的儿童患者中，虚弱+ECI表现出强大的预测医院LOS和非常规出院处置的能力。这些发现表明，结合这些指标可以提高对该人群术后预后的预测。虽然需要进一步的研究，但这些发现可以作为风险评估指标，以协调患者及其家属在手术后的护理计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Neurosurgery 医学-临床神经学

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Articles in ''Pediatric Neurosurgery'' strives to publish new information and observations in pediatric neurosurgery and the allied fields of neurology, neuroradiology and neuropathology as they relate to the etiology of neurologic diseases and the operative care of affected patients. In addition to experimental and clinical studies, the journal presents critical reviews which provide the reader with an update on selected topics as well as case histories and reports on advances in methodology and technique. This thought-provoking focus encourages dissemination of information from neurosurgeons and neuroscientists around the world that will be of interest to clinicians and researchers concerned with pediatric, congenital, and developmental diseases of the nervous system.