Predicting shunt failure on the basis of clinical symptoms and signs in children
Predicting shunt failure on the basis of clinical symptoms and signs in children
复制标题
DOI：
10.3171/jns.2001.94.2.0202
复制
发表时间：
2001-02-01
影响因子：
4.1
通讯作者：
Drake, JM
中科院分区：
文献类型：
--
作者：
Garton, HJL;Kestle, JRW;Drake, JM
Object.在评估儿科患者的分流功能障碍时，症状和体征的预测值在决定哪些患者应该接受影像学检查时非常重要，而确定与分流失败概率低相关的临床结果可以简化管理。对最近完成的儿科分流设计试验（PSDT）期间获得的数据进行了分析。计算分流失败症状和体征的预测值。为了改善预测能力，分流评分的基础上，一组的迹象和症状的衍生和验证使用multivariate methods.431例患者的遭遇后，最近的分流插入进行了分析。对于分流管插入后5个月内发生的事件（早期接触），症状和体征的预测值包括：恶心和呕吐（阳性预测值[PPV] 79%，似然比[LR] 10.4），易怒（PPV 78%，LR 9.8）、意识水平降低（HRV）（PPV 100%）、红斑（PPV 100%）和<$门隆起（PPV 92%，LR 33.1）。在分流管插入后9个月至2年（晚期接触），只有发育里程碑丢失（PPV 83%，LR 36.7）和可接受性降低（PPV 100%）与分流管失败密切相关。然而，如果没有症状或体征，分流失败的可能性仍为15 - 29%（早期就诊组）或9 - 13%（晚期就诊组）。使用针对早期就诊制定的分流评分（根据存在的具体症状或体征，从1分到3分），评分为0、1、2和3分或更高的患者的分流失败率分别为4%、50%、75%和100%。使用晚期就诊的分流评分，评分为0、1和2或更高的患者的分流失败率分别为8%、38%和100%。在儿童中，在分流管插入后的前几个月内发生的某些症状和体征与分流管故障密切相关;然而，这些症状和体征的个体缺失仅使临床医生排除分流管故障的能力有限。将它们结合在加权评分系统中，可以提高根据临床结果预测分流失败的能力。
Object. In evaluating pediatric patients for shunt malfunction, predictive values for symptoms and signs are important in deciding which patients should undergo an imaging study, whereas determining clinical findings that correlate with a low probability of shunt failure could simplify management.Methods. Data obtained during the recently completed Pediatric Shunt Design Trial (PSDT) were analyzed. Predictive values were calculated for symptoms and signs of shunt failure. To refine predictive capability, a shunt score based on a cluster of signs and symptoms was derived and validated using multivariate methods.Four hundred thirty-one patient encounters after recent shunt insertions were analyzed. For encounters that took place within 5 months after shunt insertion (early encounters), predictive values for symptoms and signs included the following: nausea and vomiting (positive predictive value [PPV] 79%, likelihood ratio [LR] 10.4), irritability (PPV 78%, LR 9.8), decreased level of consciousness (LOC) (PPV 100%), erythema (PPV 100%), and bulging fontanelle (PPV 92%, LR 33.1). Between 9 months and 2 years after shunt insertion (late encounters), only loss of developmental milestones (PPV 83%, LR 36.7) and decreased LOC (PPV 100%) were strongly associated with shunt failure. However, the absence of a symptom or sign still left a 15 to 29% (early encounter group) or 9 to 13% (late encounter group) chance of shunt failure. Using the shunt score developed for early encounters, which sums from 1 to 3 points according to the specific symptoms or signs present, patients with scores of 0, 1, 2, and 3 or greater had shunt failure rates of 4%, 50%, 75%, and 100%, respectively. Using the shunt score derived from late encounters, patients with scores of 0, 1, and 2 or greater had shunt failure rates of 8%, 38%, and 100%, respectively.Conclusions. In children, certain symptoms and signs that occur during the first several months following shunt insertion are strongly associated with shunt failure; however, the individual absence of these symptoms and signs offers the clinician only a limited ability to rule out a shunt malfunction. Combining them in a weighted scoring system improves the ability to predict shunt failure based on clinical findings.