Predictors of Ventriculoperitoneal Shunt Placement in Adult Patients with Aneurysmal Subarachnoid Haemorrhage: understanding the pathophysiology of Cerebrospinal fluid changes after aneurysmal subarachnoid hemorrhage
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".