Predictors of Ventriculoperitoneal Shunt Placement in Adult Patients with Aneurysmal Subarachnoid Haemorrhage: understanding the pathophysiology of Cerebrospinal fluid changes after aneurysmal subarachnoid hemorrhage
Notice bibliographique
Résumé
Abstracts Introduction and aim of the study:Aneurysmal subarachnoid hemorrhage (aSAH) presents a formidable neurological challenge affecting 80% of non-traumatic SAH cases. Hydrocephalus develops in 20-30% of aSAH patients, resulting in further neurological cognitive impairment. Management involves temporary external ventricular drain (EVD) placement to alleviate elevated intracranial pressure. Some patients become EVD-dependent, necessitating permanent ventriculoperitoneal shunt (VPS) insertion. Predictors for VPS insertion in adult aSAH patients remain unclear, so the primary objective of this study is to identify those predictors, so as to afford better clinical decision-making and to improve patient outcomes.Methodology: This retrospective cohort study includes adult patients diagnosed with aSAH admitted to the Montreal Neurological Hospital from January 2015 to December 2020. Regarding the potential predictors of VPS, variables were first elucidated and better defined through a recent literature review. The data variables were then collected from medical records encompassing demographic details (age, sex), clinically relevant medical history (hypertension, diabetes, smoking, alcohol use), radiological findings (Evan’s Index, Modified Fisher Score, Graeb score), and treatment methods (surgical clipping, endovascular treatment). The primary study outcome was VPS placement during hospital admission. The secondary outcome measure was the length of hospital stay. Descriptive statistics were summarized on demographic and clinical characteristics. Univariate analysis, using a chi-square test for categorical variables, and a t-test, or Wilcoxon rank-sum test for continuous variables, was employed to identify factors associated with VPS placement. Unconditional multivariable logistic regression was employed on all predictors of VPS insertion to determine predictors of VPS placement.Results: In our study of 143 patients, 29% required VP shunt insertion. Comparing shunted versus non-shunted groups there were no significant differences found in several variables. However, those needing shunts had a slightly longer hospital stay. Hypertension was higher in the non-shunted group, and larger aneurysms were more prevalent. A higher Hunt and Hess score, a higher modified Fisher’s scale score, and a higher modified Graeb score were each associated with an increased shunt placement likelihood.Conclusion: In patients with aneurysmal subarachnoid hemorrhage, higher Hunt and Hess, modified Fisher, and a modified Graeb score were each linked to an increased likelihood of needing a shunt. Hypertension and harbouring a smaller aneurysm were each associated with an increased likelihood of having a shunt placed. Recognizing these risks is crucial when considering shunt placement for improved patient care. Further research is needed to fully validate these findings
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 machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 source (Gemma direct ou Codex distillé), 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 ».