Which Sagittal Evaluation System Can Effectively Predict Mechanical Complications in the Treatment of Elderly Patients With Adult Degenerative Scoliosis? Roussouly Classification or Global Alignment and Proportion (GAP) Score

Abstract Background: To achieve the proper sagittal alignment, previous studies have developed different assessment systems for degenerative spinal deformity which could help us in making treatment strategies. The purpose of our study is to evaluate whether Roussouly classification or GAP score is more appropriate in the prediction of mechanical complications after surgical treatment of ADS.Methods: The ADS patients who received long segmental fusion in the treatment during the period from December 2016 to December 2018 were evaluated in this study. The basic information of the patients and all radiologic measurements, which were included in GAP score and Roussouly classification, were collected for analysis. Patients were divided into two groups according to occurrence or absence of mechanical complications for comparison. The correlation between evaluation systems and mechanical complications could be analyzed in logistic regression model via stepwise backward elimination based on the Wald statistics. ROC curve was used to determine the predictability of the evaluation systems in the occurrence of mechanical complications and calculate their cut-off value. A two-tailed P value < 0.05 was statistically significant for all statistical tests.Results: A total of 80 cases were included in this study. The results of logistic regression showed: GAP score (P = 0.008) and GAP categories (P = 0.007) were positively correlated with mechanical complications; Roussouly score was negatively correlated with mechanical complications (P=0.034); GAP score was positively correlated with PJK (P = 0.021); Roussouly score was negatively correlated with implant-related complications (P = 0.018); GAP categories were correlated with implant loosening (P = 0.023). Results of ROC showed that GAP score was most effective in predicting PJK (AUC = 0.863) and PJF (AUC = 0.724); GAP categories (AUC = 0.561) was more effective than GAP score (AUC = 0.555) in predicting implant-related complications.Conclusions: Roussouly-type matching could not accurately predict the risk of mechanical complications. In contrast, GAP score was most effective in predicting PJK and PJF. The GAP score was better than Roussouly classification in predicting mechanical complications.

Download Full-text

Which Sagittal Assessment System Can Effectively Predict the Risk of Mechanical Complications in the Treatment of Elderly Patients With Adult Degenerative Scoliosis? Roussouly Classification or Global Alignment and Proportion (GAP) Score

10.21203/rs.3.rs-576568/v1 ◽

2021 ◽

Author(s):

Xiangyao Sun ◽

Wenzhi Sun ◽

Siyuan Sun ◽

Hailiang Hu ◽

Sitao Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Statistical Tests ◽

Treatment Strategies ◽

Assessment System ◽

P Value ◽

Global Alignment ◽

Evaluation Systems ◽

Mechanical Complications ◽

Adult Degenerative Scoliosis ◽

Roussouly Classification

Abstract Background: In order to achieve the proper sagittal alignment, previous studies have developed different assessment systems for degenerative spinal deformity which could help us in making treatment strategies. The purpose of our study is to evaluate whether Roussouly classification or GAP score is more appropriate in the prediction of mechanical complications in the treatment of ADS.Methods: The ADS patients who received long segmental fusion in the treatment during the period from December 2016 to December 2018 were evaluated in this study. The basic information of the patients and all radiologic measurements, which were included in GAP score and Roussouly classification, were collected for analysis. Patients were divided into two groups according to occurrence or absence of mechanical complications for comparison. The correlation between evaluation systems and mechanical complications could be analyzed in logistic regression model via stepwise backward elimination based on the Wald statistics. ROC curve was used to determine the predictability of the evaluation systems in the occurrence of mechanical complications and calculate their cut-off value. A two-tailed P value < 0.05 was statistically significant for all statistical tests.Results: A total of 80 cases were included in this study. The results of logistic regression showed: GAP score (P = 0.008) and GAP categories (P = 0.007) were positively correlated with Mechanical complications; Roussouly score was negatively correlated with mechanical complications (P=0.034); GAP score was positively correlated with PJK (P = 0.021); Roussouly score was negatively correlated with implant-related complications (P = 0.018); GAP categories were correlated with implant loosening (P = 0.023). Results of ROC showed that GAP score was mostly effective in predicting PJK (AUC = 0.863) and PJF (AUC = 0.724); GAP categories (AUC = 0.561) was more effective than GAP score (AUC = 0.555) in predicting implant-related complications.Conclusions: Roussouly-type matching could not accurately predict the risk of mechanical complications. In contrast, GAP score was mostly effective in predicting PJK and PJF. The GAP score was better than Roussouly classification in predicting mechanical complications.

Download Full-text

Which sagittal evaluation system can effectively predict mechanical complications in the treatment of elderly patients with adult degenerative scoliosis? Roussouly classification or Global Alignment and Proportion (GAP) Score

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02786-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xiangyao Sun ◽

Wenzhi Sun ◽

Siyuan Sun ◽

Hailiang Hu ◽

Sitao Zhang ◽

...

Keyword(s):

Evaluation System ◽

Treatment Strategies ◽

Area Under The Curve ◽

Global Alignment ◽

Mechanical Complication ◽

Degenerative Scoliosis ◽

Evaluation Systems ◽

Mechanical Complications ◽

Adult Degenerative Scoliosis ◽

Roussouly Classification

Abstract Background To achieve the proper sagittal alignment, previous studies have developed different assessment systems for adult degenerative scoliosis (ADS) which could help the spine surgeon in making treatment strategies. The purpose of our study is to evaluate whether Roussouly classification or global alignment and proportion (GAP) score is more appropriate in the prediction of mechanical complications after surgical treatment of ADS. Methods ADS patients who received long segmental fusion in the treatment during the period from December 2016 to December 2018 were evaluated in this study. Basic information and radiologic measurements were collected for analysis. Patients were divided into two groups according to occurrence or absence of mechanical complications for comparison. Mechanical complications included proximal junctional kyphosis (PJK), proximal junctional failure (PJF). GAP categories divided GAP score into proportioned spinopelvic position, moderately disproportioned position, and severely disproportioned position according to the cut-off values. The correlation between evaluation systems and mechanical complications was analyzed through a logistic regression model via stepwise backward elimination based on the Wald statistics. Receiver operator characteristic (ROC) curve was used to determine the predictability of the evaluation systems in the occurrence of mechanical complications and calculate their cut-off value. Area under the curve (AUC) was used to evaluate the validity of the thresholds. Results A total of 80 patients were included in this study. There were 41 patients in mechanical complication group and 39 patients in no mechanical complication group. GAP score (P = 0.008) and GAP categories (P = 0.007) were positively correlated with mechanical complications; Roussouly score was negatively correlated with mechanical complications (P = 0.034); GAP score was positively correlated with PJK (P = 0.021); Roussouly score was negatively correlated with implant-related complications (P = 0.018); GAP categories were correlated with implant loosening (P = 0.023). Results of ROC showed that GAP score was more effective in predicting PJK (AUC = 0.863) and PJF (AUC = 0.724) than Roussouly score; GAP categories (AUC = 0.561) was more effective than GAP score (AUC = 0.555) in predicting implant-related complications. Conclusions Roussouly classification could only be a rough estimate of optimal spinopelvic alignment. Quantitative parameters in GAP score made it more effective in predicting mechanical complications, PJK and PJF than Roussouly classification.

Download Full-text

Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01745-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xiang Li ◽

Lingtong Shan ◽

Mengwei Lv ◽

Zhi Li ◽

Chunyan Han ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Risk Evaluation ◽

Evaluation System ◽

Myocardial Injury ◽

Predictive Ability ◽

Discrimination Power ◽

Evaluation Systems ◽

Risk Evaluation System ◽

Injury Classification

Abstract Background Preoperative risk evaluation systems are significant and important to the allocation of medical resources and the communication between doctors and patients. The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is widely used in clinical practice. Cardiac troponin T (cTnT) can specifically and accurately reflect myocardial injury. Whether EuroSCORE II can improve the predictive power after integrating with cTnT is still unclear. This study was a retrospective single center study designed to assess the predictive ability of EuroSCORE II integrated with cTnT for patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG). Methods This retrospective and observational cohort study included 1887 patients who underwent first isolated OPCABG. cTnT was detected within 48 h before operation in each patient. According to myocardial injury, patients were divided by cTnT into 4 stages. A new risk evaluation system was created through logistic regression with EuroSCORE II and myocardial injury classification as covariates. Then the two risk evaluation systems were comparatively assessed by regression analysis, receiver operator characteristic curves, net reclassification index, Bland–Altman plots and decision curve analysis. Results There were 43 in-hospital deaths, with a mortality of 2.30% (43/1887). The logistic regression analysis showed that preoperative myocardial injury classification was a significant risk factor for in-hospital mortality in both total cohort (OR 1.491, 95%CI 1.049–2.119) and subsets (OR 1.761, 95%CI 1.102–2.814). The new risk evaluation system has higher calibration and discrimination power than EuroSCORE II, both for overall cohort and subsets. Especially, the new system has obvious advantages in discrimination power in the subset of acute myocardial infarction (AUC 0.813 vs. 0.772, 0.906 vs. 0.841, and 0.715 vs. 0.646, respectively). Conclusions Both myocardial injury classification and EuroSCORE II are independent risk factors of in-hospital mortality in OPCABG patients. The new risk evaluation system has higher predictive ability than EuroSCORE II, especially in patients with a recent history of AMI.

Download Full-text

Partial Intraoperative Global Alignment and Proportion Scores Do Not Reliably Predict Postoperative Mechanical Failure in Adult Spinal Deformity Surgery

Global Spine Journal ◽

10.1177/2192568220935438 ◽

2020 ◽

pp. 219256822093543

Author(s):

Alex S. Ha ◽

Daniel Y. Hong ◽

Josephine R. Coury ◽

Meghan Cerpa ◽

Griffin Baum ◽

...

Keyword(s):

Logistic Regression ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Mechanical Failure ◽

Global Alignment ◽

Mechanical Complications ◽

Plane Analysis ◽

Spinal Deformity Surgery ◽

Distribution Index

Study Design: Retrospective radiographic review. Objectives: The Global Alignment and Proportion (GAP) score allows sagittal plane analysis for deformity patients and may be predictive of mechanical complications. This study aims to assess the effectiveness of predicting mechanical failure based on partial intraoperative GAP (iGAP) scores. Methods: A retrospective radiographic review was performed on 48 deformity patients between July 2015 to January 2017 with a 2-year follow-up. Using the same methodology as the original GAP study, the partial iGAP score was calculated with the sum of the scores for age, relative lumbar lordosis (RLL), and lordosis distribution index (LDI). Therefore, the iGAP score (0-7) was grouped into proportional (0-2), mildly disproportionate (3-5), and severely disproportionate (6-7). Logistic regression was performed to assess the ability of the partial iGAP score to predict postoperative mechanical failure. Results: The mean iGAP for patients with a mechanical failure was 3.54, whereas the iGAP for those without a mechanical failure was 3.46 ( P = .90). The overall mechanical failure rate was 27.1%. The mechanical failures included 8 proximal junctional kyphosis, 7 rod fractures, and 1 rod slippage from the distal end of the construct. Logistic regression analysis revealed that the partial iGAP score was not able to predict postoperative mechanical failure (χ2 = 1.4; P = .49). Conclusion: The iGAP scores for RLL or LDI did not show any significant correlation to postoperative mechanical failure. Ultimately, the proposed partial iGAP score did not predict postoperative mechanical failure and thus, cannot be used as an intraoperative alignment assessment to avoid postoperative mechanical complications.

Download Full-text

The Application of Electric Impedance Tomography During the Ventilator Weaning Process

10.21203/rs.3.rs-763616/v1 ◽

2021 ◽

Author(s):

Guan Wang ◽

Lei Zhang ◽

Bin Li ◽

Bingyin Niu ◽

Jian Jiang ◽

...

Keyword(s):

Logistic Regression ◽

Success Rate ◽

Evaluation System ◽

Spontaneous Breathing Trial ◽

Region Of Interest ◽

Ventilator Weaning ◽

Control Group ◽

P Value ◽

Trial Group ◽

Impedance Tomography

Abstract Background The existing evaluation system for ventilator weaning should consider adding new reference indicators to improve the weaning success rate. In the present study, we proposed investigating whether electrical impedance tomography (EIT) is a useful predictor for ventilator weaning. Methods The study design was a nested case–control study, and patients who were admitted to the intensive care unit and underwent their first tracheal intubation were enrolled. Those who successfully completed the ventilator weaning and extubation after the first spontaneous breathing trial (SBT) were included in the trial group, while those who did not pass the SBT or who received secondary intubation within 48 hours after extubation were included in the control group. Here, EIT was adopted to record the monitoring data in three phases, i.e., before the SBT (pre-SBT), during the SBT (SBT), and after the SBT (post-SBT), in both groups. The MATLAB 7.2 software was used to process the EIT data, the SAS 9.4 software was adopted for the statistical analysis, and logistic regression was used to analyze the factors associated with weaning success. Results A total of 53 patients were enrolled, including 41 cases in the trial group and 12 cases in the control group. The logistic regression analysis showed that the pre-SBT global impedance (GI) and the SBT region of interest 2 (ROI2) were significantly higher in the trial group than in the control group (p = 0.0001 and p = 0.002). The pre-SBT GI predicted weaning success with a sensitivity of 0.524, a specificity of 0.818, a p-value of 0.0496, and a 95% confidence interval (CI) of 0.001–0.978. The sensitivity, specificity, p-value, and 95% CI for the SBT ROI2 were 1, 0.595, 0.0164, and 1.010–1.108, respectively. Conclusion For patients without contraindications to EIT, the application of EIT is recommended to be added to the existing evaluation system for ventilator weaning as it could help improve the weaning success rate. Further cohort studies are needed to investigate the actual efficacy of EIT after it has been added to the evaluation system.

Download Full-text

Sikap Ayah dan Jumlah Anak serta Praktik Air Susu Ibu Eksklusif

Kesmas National Public Health Journal ◽

10.21109/kesmas.v8i5.389 ◽

2013 ◽

Vol 8 (5) ◽

pp. 229

Author(s):

Suci Destriatania ◽

Judhiastuty Februhartanty ◽

Fatmah Fatmah

Keyword(s):

Logistic Regression ◽

Exclusive Breastfeeding ◽

Positive Attitude ◽

Statistical Tests ◽

Dominant Factor ◽

P Value ◽

Chi Square ◽

Cross Sectional ◽

Feeding Method ◽

Breastfeeding Practice

Partisipasi ayah pada pola pemberian makan bayi harus dipersiapkan dengan baik sehingga mendukung ibu untuk menyusui. Penelitian ini bertujuan untuk mengetahui hubungan antara pengetahuan dan sikap ayah terhadap praktik pemberian ASI eksklusif. Sampel dalam penelitian ini adalah 536 pasangan suami istri yang mempunyai bayi usia 0-6 bulan. Data dikumpulkan dengan menggunakan kuesioner terstruktur. Desain yang digunakan adalah potong lintang dan analisis data menggunakan kai kuadrat dan regresi logistik. Rata-rata pemberian ASI eksklusif pada saat wawancara adalah 29,1%. Sekitar 83,6% dan 59,1% ayah mempunyai pengetahuan rendah tentang manajemen laktasi prenatal dan postnatal, tetapi 89,6% dan 61,9% ayah menunjukkan sikap positif terhadap praktik menyusui ketika masa kehamilan dan menyusui. Dukungan ayah terhadap praktik menyusui justru rendah pada saat persalinan (37,3%). Sikap ayah selama masa menyusui (nilai p < 0,05; OR = 1,623; 95%CI = 1,086 _ 2,425) merupakan faktor yang paling dominan memengaruhi praktik pemberian ASI eksklusif setelah dikontrol faktor lainnya dalam analisis regresi logistik. Pengetahuan yang baik dan sikap yang positif diketahui sebagai faktor penting dalam keberhasilan praktik pemberian ASI eksklusif. Hal ini menunjukkan kebutuhan keterlibatan ayah dalam berbagai program promosi praktik menyusui.Fathers participation in the decision making of infant feeding method have to be well prepared so that they can support mothers to breastfeed. The objective of the paper is to analyze the relationship between knowledge and attitude of the fathers on exclusive breastfeeding practice. Couples whose baby aged 0-6 months were recruited in this study. Structured questionnaire was used to collect the data. The study design was cross sectional in which chi square and logistic regression analyses were used for the statistical tests. The prevalence of exclusive breastfeeding at time of interviewwas 29.1%. Around 83.6% and 59.1% of fathers had low level of knowledge on prenatal and postnatal lactation management but 89.6% and 61.9% had positive attitude toward breastfeeding. Only 37.3% fathers showed positive attitude about breastfeeding during labor. Attitude of fathers during nursing period was a dominant factor associated with exclusive breastfeeding (p value < 0.05; OR = 1.623; 95% CI = 1.086 _ 2.425) after controlling for other factors in the logistic regression analysis. Good knowledge and positive attitude were known as important factors for successful exclusive breastfeeding practice. This indicates a need of breastfeeding education for fathers.

Download Full-text

HUBUNGAN ASUPAN PROTEIN, OMEGA 3, OMEGA 6 DAN ZINK TERHADAP TUMBUH KEMBANG BALITA

JURNAL MEDIA KESEHATAN ◽

10.33088/jmk.v7i2.239 ◽

2018 ◽

Vol 7 (2) ◽

pp. 150-156

Author(s):

Indria Pijaryani

Keyword(s):

Logistic Regression ◽

Nutritional Status ◽

Growth And Development ◽

Statistical Tests ◽

Normal Growth ◽

P Value ◽

Multiple Logistic Regression ◽

Omega 3 ◽

Cross Sectional ◽

Omega 6

The growth and development is an evolutionary process that includes the stages of change through a physical , cognitive , and emotional that can be identified . From the initial survey conducted by the researchers found two toddler nutrition toddler skinny and one fat nutritional status with the percentage ( 50 % ) are not age-appropriate development . This study used a cross sectional. Seen from the growth and nutritional status of pre- screening questionnaire development (KPSP). The sample amounted to 96 toddlers . Proportional sampling technique using random sampling . Data was collected through primary and secondary data . Data processed Chi-square test and multiple logistic regression . The results of both studies of protein intake with corresponding growth as much as 94.3 % , statistical tests showed no correlation with p value of 0.00 . Intake of omega- 3 well with normal growth and development as much as 96.2 % , statistical tests showed no p value of 0.008 . Intake of omega- 6 well with normal growth and development as much as 95 % , statistical tests showed no correlation with p value of 0.042. Zinc intake well with the corresponding growth as much as 95.7 % , statistical tests showed no correlation with p value 0.019 . Results of multiple logistic regression known intake of omega 3 are factors that influence the growth and development of the value ekponen is 9.209 , so the omega- 3 chance 9.2 times affect the growth and development of infants.

Download Full-text

HUBUNGAN DUKUNGAN KELUARGA TERHADAP TINGKAT KEMANDIRIAN ANAK RETARDASI MENTAL

Jurnal Keperawatan ◽

10.32583/keperawatan.v11i2.427 ◽

2019 ◽

Vol 11 (2) ◽

pp. 87-92

Author(s):

Dwi Indah Iswanti ◽

Fery Agusman Motuho Mendrofa ◽

Diyanto Diyanto

Keyword(s):

Family Support ◽

Quantitative Method ◽

Statistical Tests ◽

Sampling Technique ◽

Mentally Retarded ◽

P Value ◽

Cross Sectional ◽

Need Support ◽

The Family ◽

Mentally Retarded Children

Kemandirian bukanlah keterampilan yang muncul secara tiba-tiba tetapi perlu diajarkan dan dilatih pada anak agar tidak menghambat tugas- tugas perkembangan anak selanjutnya. Terutama pada anak yang mengalami retardasi mental akan sangat membutuhkan dukungan dari keluarga. Tujuan penelitian untuk mengetahui hubungan dukungan keluarga dengan tingkat kemandirian anak retardasi mental di SLB Negeri Semarang. Penelitian ini menggunakan metode kuantitatif dengan pendekatan cross sectional. Populasi dalam penelitian ini adalah seluruh orang tua siswa kelas IV-VI di SLB Negeri Semarang yang berjumlah 64 siswa. Teknik sampling yang digunakan adalah total sampling. Dukungan keluarga pada anak retardasi mental sebagian besar adalah mendukung yaitu sebanyak 53,1%, kemandirian anak retardasi mental sebagian besar adalah kurang mandiri yaitu sebanyak 53,1%. Hasil uji statistik menemukan ada hubungan antara dukungan keluarga dengan kemandirian anak retardasi mental di SLB Negeri Semarang, dengan p value sebesar 0,000. Kata kunci : dukungan keluarga, kemandirian anak retardasi mental THE CORRELATION BETWEEN FAMILY SUPPORT AND THE LEVEL OF INDEPENDENCE OF MENTALLY RETARDED CHILDREN ABSTRACT Independence is not a skill that emerges suddenly but needs to be taught and trained in children so as not to inhibit the tasks of further child development. Especially for children who are mentally retarded, they will need support from the family. Research objectives to find out the correlation between family support and the level of independence of mentally retarded children in extraordinary school State of Semarang. This study uses a quantitative method with a cross sectional approach. The population in this study were all parents of students in class IV-VI in Semarang State SLB, amounting to 64 students. The sampling technique used is total sampling. Family support for mentally retarded children was mostly supportive, as much as 53.1%, the independence of most mentally retarded children was less independent, which was as much as 53.1%. The results of statistical tests found that there was a correlation between family support and the independence of mentally retarded children in Semarang State SLB, with a p value of 0,000. Keywords: family support, independence of mentally retarded children

Download Full-text

Analisis Faktor Determinan Pelaksanaan Inisiasi Menyusu Dini Oleh Bidan Di Rumah Sakit Umum Anutapura Palu

Jurnal Bidan Cerdas (JBC) ◽

10.33860/jbc.v1i1.87 ◽

2018 ◽

Vol 1 (1) ◽

pp. 34

Author(s):

Ni Nyoman Novita ◽

Gusman Arsyad

Keyword(s):

Emergency Room ◽

Peer Support ◽

Statistical Tests ◽

Bivariate Analysis ◽

P Value ◽

Chi Square ◽

Cross Sectional ◽

Implementation Processes ◽

Chi Square Test ◽

The Government

Implementation of IMD in hospitals has decreased from the previous year and has not reached the target set by the government. Some IMD implementation processes have not been carried out according to applicable standards. So that babies do not get an IMD in accordance with existing SOPs. The purpose of this study was to determine the determinant factors associated with the implementation of the IMD by midwives in the Midwifery and Maternity Room Emergency Room (IGD) at the Anutapura General Hospital in Palu. This research method is analytical with cross sectional approach. The population of this study was that all midwives in the obstetrics emergency room and maternity room at Anutapura Palu Hospital were 37 respondents. The sample in this study is total sampling. The analysis used was univariate, and bivariate analysis using the chi square test with a confidence level of 95% (α = 0.05). The results of statistical tests on variable knowledge of midwives with the implementation of IMD p value: 0.018 (p value <0.05). APN training with the implementation of IMD p value: 0.697 (p value> 0.05). length of work with the implementation of IMD p value: 0.029 (p value <0.05). and peer support with the implementation of IMD p value: 0.007 (p value <0.05). Conclusions there is a relationship between knowledge, length of work, peer support with the implementation of the IMD, and training factors that have nothing to do with IMD implementation. The strongest factor in the relationship is peer support. It is recommended that the Anutarapura Palu Hospital be able to motivate midwives so that they can further enhance their role in the implementation and provide support to their colleagues so that the implementation of the IMD can be carried out in accordance with applicable standards.Keywords: Knowledge, APN Training, Duration of work, Implementation of IMD

Download Full-text

Epidemiology of pediatric hydrocephalus in Haiti: analysis of a surgical case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.12.peds18568 ◽

2019 ◽

Vol 23 (5) ◽

pp. 568-576

Author(s):

Michael Ragheb ◽

Ashish H. Shah ◽

Sarah Jernigan ◽

Tulay Koru-Sengul ◽

John Ragheb

Keyword(s):

Public Health ◽

Logistic Regression ◽

Head Circumference ◽

Rainy Season ◽

Statistical Tests ◽

Multivariate Logistic Regression Analysis ◽

Case Series ◽

Multivariate Logistic Regression ◽

Surgical Case ◽

Operative Notes

OBJECTIVEHydrocephalus is recognized as a common disabling pediatric disease afflicting infants and children disproportionately in the developing world, where access to neurosurgical care is limited and risk of perinatal infection is high. This surgical case series describes the Project Medishare Hydrocephalus Specialty Surgery (PMHSS) program experience treating hydrocephalus in Haiti between 2008 and 2015.METHODSThe authors conducted a retrospective review of all cases involving children treated for hydrocephalus within the PMHSS program in Port-au-Prince, Haiti, from 2008 through 2015. All relevant epidemiological information of children treated were prospectively collected including relevant demographics, birth history, hydrocephalus etiology, head circumference, and operative notes. All appropriate associations and statistical tests were performed using univariate and multivariate logistic regression analyses.RESULTSAmong the 401 children treated within PMHSS, postinfectious hydrocephalus (PIH) accounted for 39.4% (n = 158) of cases based on clinical, radiographic, and endoscopic findings. The majority of children with hydrocephalus in Haiti were male (54.8%, n = 197), born in the rainy season (59.7%, n = 233), and born in a coastal/inland location (43.3%, n = 61). The most common surgical intervention was endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) (45.7%, n = 175). Multivariate logistic regression analysis yielded coastal birth location (OR 3.76, 95% CI 1.16–12.18) as a statistically significant predictor of PIH. Increasing head circumference (adjusted OR 1.06, 95% CI 0.99–1.13) demonstrated a slight trend toward significance with the incidence of PIH.CONCLUSIONSThis information will provide the foundation for future clinical and public health studies to better understand hydrocephalus in Haiti. The 39.4% prevalence of PIH falls within observed rates in Africa as does the apparently higher prevalence for those born during the rainy season. Although PIH was the most frequent etiology seen in almost all birth locations, the potential relationship with geography noted in this series will be the focus of further research in an effort to understand the link between climate and PIH in Haiti. The ultimate goal will be to develop an appropriate public health strategy to reduce the burden of PIH on the children of Haiti.

Download Full-text