Artikel
Validation of the ETV success score in pediatric and adult patients – a single center analysis of 294 ETV
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Autoren
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Sascha Marx
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Markus Vollmer
- Universitätsmedizin Greifswald, Institut für Bioinformatik, Greifswald, Deutschland
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Christin Gasch
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Viktoria Richter
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Eva Maria Lemke
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Steffen K. Fleck
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Soenke Langner
- Universitätsmedizin Greifswald, Institut für Radiologie and Neuroradiologie, Greifswald, Deutschland
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Michael R. Gaab
- KRH Klinikum Nordstadt, Hannover, Deutschland
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Jörg Baldauf
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Henry W. S. Schroeder
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: To predict the clinical response following endoscopic third ventriculostomy (ETV) in pediatric patients, the ETV Success Score (ETVSS) was proposed in 2009 by Kulkarni et al. The score is based on the patient age, the cause of hydrocephalus, and the presence of a previous shunt. The aim of the present study was to validate the ETVSS in our institution. In addition to the pediatric population, we also validated the ETVSS for adult patients.
Methods: All ETV procedures have been gathered in a prospectively maintained database since 1993. We reviewed all appropriate patients until 2016 with at least six months follow up time with regard to the success criteria (no further CSF diverting procedure or deaths due to hydrocephalus within six months after ETV) and success predicting factors (age, cause of hydrocephalus, previous shunt) obtained in the ETVSS. Observed success rates were computed with 95% exact confidence intervals and compared to the predicted success. Goodness-of-fit tests were conducted to check the predictability of ETVSS for both children and adults. The diagnostic ability of ETVSS was analyzed by computation of the receiver operating characteristic (ROC) curve.
Results: 294 ETV were included in the study period from 1993 to 2016 in 199 adult patients (86 f, 113 m, mean age 50.6 years, ranging from 18 to 85 years) and 95 pediatric patients (48 f and 47 m, mean age 6.5 years, ranging from 0 to 17 years). ETV was successful in 66.3% of children and 80.4% of adults after six months. The respective mean ETVSS was 67.8% in children and 83.1% in adults. The area under the ROC curve (AUC) was 0.62 in children and 0.59 in adults, revealing weaknesses in specificity and sensitivity when predicting the success of ETV using ETVSS.
Conclusion: With the present data we were able to validate the ETVSS, not only in the population of pediatric patients, but also for adult patients. We found no differences between ETVSS prediction and observed success rates. However, the low AUC values revealed limited predictive power and we strongly suggest to improve preoperative success measurement, perhaps by establishing a new score.
