Predictor of a permanent shunt after treatment of external ventricular draining in pediatric postinfective hydrocephalus—a retrospective cohort study

Abstract

Purpose

To assess the therapeutic efficacy of external ventricular draining (EVD) and to predict the need for permanent shunts in infants with postinfective hydrocephalus (PIHC).

Methods

This is a retrospective study of infants diagnosed with PIHC and treated by EVD between January 2013 and December 2017 at the Children’s Hospital of Fudan University. Clinical, laboratory, and imaging data were collected and analyzed to identify independent risk factors by logistic regression analyses. The predictor was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curves.

Results

In total, 48 patients were identified, and 31 cases (64.5%) had a permanent shunt. EVD was effective in accelerating cerebrospinal fluid purification. In the permanent shunt group, the duration of EVD was significantly longer (28.5 ± 5.2 vs 14.9 ± 3.0 P < 0.05) and the frontal and occipital horn ratio (FOHR) at 7–10 days after EVD was significantly higher (0.57 ± 0.01 vs 0.48 ± 0.01 P < 0.001). The FOHR at 7–10 days after EVD predicts the need for a permanent shunt with an area under the ROC curve of 0.818.

Conclusion

EVD was effective for purification of CSF, whereas a permanent shunt was needed for more than half of the patients. The FOHR at 7–10 days after EVD may be a strong predictor for a permanent shunt.

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Data availability

All data were available.

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Authors

Contributions

Yi Zhang:

• Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data;

• Drafting the article or revising it critically for important intellectual content;

• Final approval of the version to be published.

Rui Zhao:

• Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data;

• Drafting the article or revising it critically for important intellectual content;

• Final approval of the version to be published.

Wei Shi:

• Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data;

• Drafting the article or revising it critically for important intellectual content;

JiCui Zheng:

• Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data;

• Drafting the article or revising it critically for important intellectual content;

Hao Li:

• Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data;

• Final approval of the version to be published.

ZhiHua Li

• Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data;

• Drafting the article or revising it critically for important intellectual content;

• Final approval of the version to be published.

Corresponding authors

Correspondence to Hao Li or ZhiHua Li.

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This study was a clinical research. This study was approved by the institutional review board of Children’s Hospital of Fudan University. Patient consent was not required.

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Zhang, Y., Zhao, R., Shi, W. et al. Predictor of a permanent shunt after treatment of external ventricular draining in pediatric postinfective hydrocephalus—a retrospective cohort study. Childs Nerv Syst (2021). https://doi.org/10.1007/s00381-021-05054-6

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Keywords

  • Postinfective hydrocephalus (PIHC)
  • Permanent shunt
  • External ventricular draining
  • Frontal and occipital horn ratio (FOHR)