验证修改后的加拿大脑积水术前预测规则,在全州范围内的儿科脑肿瘤队列中准确预测脑积水。

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
Barnabas Obeng-Gyasi, Trenton A Line, Anoop S Chinthala, Jignesh Tailor
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引用次数: 0

摘要

目的:修订加拿大脑积水术前预测规则(mCPPRH),以预测儿童后颅窝肿瘤(PFT)是否需要永久性脑脊液分流。本研究旨在外部验证113名儿科PFTs患者的mCPPRH。方法:我们进行回顾性分析,计算每位患者的mCPPRH评分,并进行受试者工作特征(ROC)曲线分析,以评估该工具的判别能力。敏感度、特异性、预测值和似然比的计算采用临界值≥5。采用双向逐步选择的多变量logistic回归来评估得分的各个组成部分。对mCPPRH组件进行了改进,并对调整后的工具进行了性能比较。结果:113例患者中,35例(31.0%)需要永久性脑脊液分流。结论:在我们的队列中,mCPPRH显示出可接受的判别能力(AUC = 0.701, 95% CI 0.608-0.795),在识别低风险患者方面具有特别的效用。然而,其较差的敏感性(34.1%)和可变的预测器性能表明,在制定治疗计划时应考虑其他临床因素,特别是在高风险病例中。建议进一步改进mCPPRH组件,以提高其实用性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Validating the modified Canadian Preoperative Prediction Rule for Hydrocephalus for accurate hydrocephalus prediction in a statewide pediatric brain tumor cohort.

Purpose: The modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH) was developed to predict the need for permanent CSF diversion in children with posterior fossa tumors (PFT). This study aimed to externally validate the mCPPRH in a cohort of 113 pediatric patients with PFTs.

Methods: We conducted a retrospective analysis, calculating the mCPPRH score for each patient and performing receiver operating characteristic (ROC) curve analysis to assess the tool's discriminative ability. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using a cutoff score of ≥ 5. Multivariable logistic regression with bidirectional stepwise selection was used to evaluate individual components of the score. The mCPPRH components were modified and the performance of adjusted tools was compared to the original.

Results: Of the 113 patients, 35 (31.0%) required permanent CSF diversion. The mCPPRH demonstrated acceptable discriminative ability (AUC = 0.701, 95% CI 0.608-0.795, p < 0.0003). Sensitivity was 34.1%, specificity 89.7%, positive predictive value 60%, and negative predictive value 75.3%. Initial regression identified no significant predictors. In stepwise regression, moderate-severe hydrocephalus independently predicted permanent CSF diversion (OR 6.37, 95% CI 1.71-41.55, p = 0.02). Increasing the age cutoff to < 5 years, removing tumor diagnosis, and modifying hydrocephalus weighting improved performance (AUC = 0.768, sensitivity 71.4%, specificity 75.6%).

Conclusions: The mCPPRH demonstrates acceptable discriminative ability (AUC 0.701) in our cohort, with particular utility in identifying low-risk patients. However, its poor sensitivity (34.1%) and variable predictor performance suggest that additional clinical factors should be considered for treatment planning, particularly in higher-risk cases. Further modification of mCPPRH components is suggested to improve its utility.

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来源期刊
Child's Nervous System
Child's Nervous System 医学-临床神经学
CiteScore
3.00
自引率
7.10%
发文量
322
审稿时长
3 months
期刊介绍: The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.
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