Obeng-Gyasi Barnabas, Line Trenton A, Chinthala Anoop S, Tailor Jignesh
Department of Neurological Surgery, Indiana University School of Medicine, 355 W 15Th St, Suite 5100, Indianapolis, IN, 46202, USA.
Division of Pediatric Neurosurgery, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA.
Childs Nerv Syst. 2025 Feb 4;41(1):105. doi: 10.1007/s00381-025-06761-0.
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.
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.
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%).
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.
制定改良的加拿大脑积水术前预测规则（mCPPRH）以预测后颅窝肿瘤（PFT）患儿进行永久性脑脊液分流的必要性。本研究旨在对113例PFT儿科患者队列进行mCPPRH的外部验证。
我们进行了一项回顾性分析，计算每位患者的mCPPRH评分，并进行受试者操作特征（ROC）曲线分析以评估该工具的判别能力。使用截断分数≥5计算敏感性、特异性、预测值和似然比。采用双向逐步选择的多变量逻辑回归来评估评分的各个组成部分。对mCPPRH的组成部分进行了修改，并将调整后工具的性能与原始工具进行了比较。
113例患者中，35例（31.0%）需要进行永久性脑脊液分流。mCPPRH显示出可接受的判别能力（AUC = 0.701，95% CI 0.608 - 0.795，p < 0.0003）。敏感性为34.1%，特异性为89.7%，阳性预测值为60%，阴性预测值为75.3%。初始回归未发现显著预测因素。在逐步回归中，中度至重度脑积水独立预测永久性脑脊液分流（OR 6.37，95% CI 1.71 - 41.55，p = 0.02）。将年龄截断值提高到<5岁、去除肿瘤诊断以及修改脑积水权重可改善性能（AUC = 0.768，敏感性71.4%，特异性75.6%）。
mCPPRH在我们的队列中显示出可接受的判别能力（AUC 0.701），在识别低风险患者方面具有特殊效用。然而，其敏感性较差（34.1%）且预测因素性能可变，这表明在制定治疗计划时应考虑其他临床因素，尤其是在高风险病例中。建议进一步修改mCPPRH的组成部分以提高其效用。
