The necessity of shunt series
Notice bibliographique
Résumé
OBJECT: This work assessed the value of shunt series in the evaluation of children with CSF shunts, a test that is frequently ordered as part of the assessment of shunt integrity. METHODS: The medical records of all children who underwent shunt series at Children's Hospital of Eastern Ontario between 1975 and 2007 were reviewed. Ancillary studies that were performed within 2 days of the shunt series (brain CT, MR imaging, ultrasonography, and radionuclide shuntography) were noted, as well as the subsequent requirement for a shunt revision. Shunt series and ancillary studies were categorized as either positive (revealing an observable sign that a shunt-related problem was present, such as shunt discontinuity on the shunt series or enlargement of the ventricles on the brain CT scan) or negative (no clear sign of a shunt-related problem). Shunt series were further grouped into shunt series performed for diagnostic reasons, shunt series performed on a routine basis during follow-up in clinic, and shunt series performed postoperatively. The length of time between shunt insertion and shunt fracture was noted. Statistical analyses were performed, including the derivation of sensitivities and specificities. RESULTS: There were 3416 shunt series in 394 patients, of which 3004 were performed with ancillary studies. On average, patients underwent 9 shunt series, with a minimum of 1 and a maximum of 43, during the follow-up period (range 3 weeks to 19 years). A total of 2493 shunt series and ancillary studies (83%) yielded negative results and no surgery was performed. One hundred thirty shunts series were negative with a positive ancillary study (4.3%) and no surgery was required. In 8.7% (261 shunt series negative, ancillary studies positive) shunt revision surgery was necessary. The opposite trend was far less prevalent (17 shunt series positive, ancillary test negative; 0.6%) in which surgery was required. There were 87 patients with 96 shunt fractures (2.8% of shunt series). The average time between shunt insertion and shunt fracture was 7.9 years (range 3 months to 18 years). Shunt series had a sensitivity of 18% and a specificity of 97%. The ancillary studies had a sensitivity of 84% and a specificity of 85%. CONCLUSIONS: The routine utilization of shunt series in the evaluation of a child with a CSF shunt is not necessary. This study showed that a very small number (0.6%) of shunt series helped in surgical decision making. Shunt series can be performed in selected cases, especially preoperatively in the absence of a baseline study to obtain information necessary for surgical planning.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».