External validation of the ETV success score in 313 pediatric patients

Published: 01-09-2019| Version 1 | DOI: 10.17632/3g9y568hhw.1
Leopoldo Furtado,
Jose Aloysio Costa Val Filho,
Eustaquio Santos Junior


The ETVSS has developed by Kulkarni et al in order to predict the clinical response following ETV based on age, previous shunt and cause of hydrocephalus in a pediatric population and has been validated in several studies across North America, Europe and the United Kingdon. Despite this fact, none validation had made in Latin America yet. The purpose was assess the ETVSS in a Brazilian pediatric population for his external validation. This Data shows all patients underwent endoscopic third ventriculostomy(ETV) performed from 1996 to 2016 in a single Brazilian institution. The ETV success score was retrospectively calculated based on age, etiology of hydrocephalus and previous shunt. Each patient data consists of identification, year of surgery, gender, age, etiology of hydrocephalus, previous central nervous system infection, previous shunt, the ETVSS prediction, kind of ETV ( Basically if it primary or secondary or redo( All redo were excluded), if other procedure was performed simultaneously ( In this case were excluded choroid plexus cauterization), intraoperative complications, postoperative complications and if the ETV was successful after six and one year after. The software application used to analyze the data was SPSS V20, Minitab 16, Excel Office 2010. A confidence level of 95% was considered. To evaluate the ETVSS in this population, the score was calculated for each patient. The predicted success rate from ETVSS was then compared with the actual success rate of ETVSS at 6 months and one year. The ROC curve was used to assess the discriminative properties of score. A result superior to 0,7 is usually satisfactory for a clinical prediction rule. The two-proportion equality test(chi-square) was used to compare the success rates among covariates age, etiology and previous shunt. Differences were considered significant at p<0,005. There were 179 boys and 134 girls ( p<0,001). Almost half of the patients, 152 (48,5%) were younger than two years old and only 63(20,1%) were 10 years or older at the time of surgery. The most commom etiologies were aqueductal stenosis (45%), non-tectal brain tumors (20,8%) and myelomeningocele (15,3%). Previous shunt were seen in 34,18% of infants. The overall success rate of ETV was 73,2% after six months and 65,2% over one year. In patients with obstructive hydrocephalus secondary to aqueduct stenosis, success was 83,6% in the first six months and 76,6% at one year. The covariates Etiology and previous shunt placement were able in discriminate success and failure during the all follow-up period. Conversely, we didn’t observe difference in the overall actual ETV success among the several groups of ages in the first six months. Were observed a discrepancy between the actual success rate and the predicted by ETVSS. In which, the tendency was underestimated the actual success in six months and one year. Furthermore, the ETVSS was able in discriminate the failure and success in both times.