The Fourth People's Hospital of Taizhou, Department of Neurosurgery - Taizhou, China.
People's Liberation Army Joint Logistic Support Force 904th Hospital, Department of Neurosurgery - Wuxi, China.
Rev Assoc Med Bras (1992). 2022 Jan;68(1):37-43. doi: 10.1590/1806-9282.20210392.
This study aimed to develop and validate a practical nomogram to predict the occurrence of post-traumatic hydrocephalus in patients who have undergone decompressive craniectomy for traumatic brain injury.
A total of 516 cases were enrolled and divided into the training (n=364) and validation (n=152) cohorts. Optimal predictors were selected through least absolute shrinkage and selection operator regression analysis of the training cohort then used to develop a nomogram. Receiver operating characteristic, calibration plot, and decision curve analysis, respectively, were used to evaluate the discrimination, fitting performance, and clinical utility of the resulting nomogram in the validation cohort.
Preoperative subarachnoid hemorrhage Fisher grade, type of decompressive craniectomy, transcalvarial herniation volume, subdural hygroma, and functional outcome were all identified as predictors and included in the predicting model. The nomogram exhibited good discrimination in the validation cohort and had an area under the receiver operating characteristic curve of 0.80 (95%CI 0.72-0.88). The calibration plot demonstrated goodness-of-fit between the nomogram's prediction and actual observation in the validation cohort. Finally, decision curve analysis indicated significant clinical adaptability.
The present study developed and validated a model to predict post-traumatic hydrocephalus. The nomogram that had good discrimination, calibration, and clinical practicality can be useful for screening patients at a high risk of post-traumatic hydrocephalus. The nomogram can also be used in clinical practice to develop better therapeutic strategies.
本研究旨在开发并验证一种实用的列线图，以预测创伤性脑损伤患者行去骨瓣减压术后发生创伤后脑积水的风险。
共纳入 516 例患者，分为训练队列（n=364）和验证队列（n=152）。通过对训练队列进行最小绝对收缩和选择算子回归分析，选择最优预测因子，然后用于构建列线图。通过验证队列的接受者操作特征曲线、校准曲线和决策曲线分析，分别评估列线图的区分度、拟合性能和临床实用性。
术前蛛网膜下腔出血Fisher 分级、去骨瓣减压术的类型、跨颅骨疝出体积、硬脑膜下血肿和功能结局均被确定为预测因子，并包含在预测模型中。该列线图在验证队列中具有良好的区分度，接受者操作特征曲线下面积为 0.80（95%CI 0.72-0.88）。校准曲线显示验证队列中列线图预测与实际观察之间具有良好的拟合度。最后，决策曲线分析表明该列线图具有显著的临床适应性。
本研究开发并验证了一种预测创伤后脑积水的模型。该列线图具有良好的区分度、校准度和临床实用性，可用于筛选创伤后脑积水风险较高的患者。该列线图还可用于临床实践，以制定更好的治疗策略。
