Recommendation for the Enrollment of Hydrocephalus Patients in Children\u27s Special Health Care Services

Recommendation for the Enrollment of Hydrocephalus Patients in Children\u27s Special Health Care Services Background: Pediatric hydrocephalus is a devastating and costly disease. The mainstay of treatment is surgical shunting of cerebrospinal fluid. These shunts fail at a high rate. The relationship between clinical decision making and shunt failure is poorly understood and multifactorial. Treatment paradigms have changed little since the 1980s. In order to investigate factors that affect outcomes, we have established the Wayne State University shunt biobank. Methods: Children\u27s Hospital of Michigan is one of the participating centers in our biobank and has enrolled 73 patients from whom we have collected 115 shunt samples and 40 CSF samples. Samples were directly obtained from the OR. CSF samples were kept cold until they were spun down and put on liquid nitrogen. The shunt samples were fixed in PFA and stored in PBS+ azide. Clinical data was taken from electronic medical records and maintained in a REDCap database under coded identifiers. Regression analysis was performed to determine factors affecting number of revisions. Results: Patient age and Medicaid usage were found to be significant predictors of the number revisions; patient weight and the median income of the family\u27s zip code were not significant predictors. The number of revisions also significantly varied by type of shunt system used. Conclusion: Many studies have used median income of a patient\u27s zip code as a stand in for socioeconomic status, our study found Medicaid enrollment to be a more significant predictor than income. This variable is commonly available in patient EMRs and merits further investigation for its usage in larger cohorts. Moreover, given that the Michigan Department of Health and Human Services has a free program to provide specialist care to children with a number of congenital conditions, among which hydrocephalus is included, it is our recommendation that hospital centers make efforts to enroll their patients in this program as it was associated with better outcomes than Medicaid. Unsurprisingly age was a very significant predictor of the number of shunt failures. The relationship between number of shunt revisions and shunt system type needs further examination to yield prognostic insight, as most patients are only placed on non-standard shunt systems after experiencing multiple failures with the standard ventriculoperitoneal shunt

Characterization of a multicenter pediatric-hydrocephalus shunt biobank

BACKGROUND: Pediatric hydrocephalus is a devastating and costly disease. The mainstay of treatment is still surgical shunting of cerebrospinal fluid (CSF). These shunts fail at a high rate and impose a significant burden on patients, their families and society. The relationship between clinical decision making and shunt failure is poorly understood and multifaceted, but catheter occlusion remains the most frequent cause of shunt complications. In order to investigate factors that affect shunt failure, we have established the Wayne State University (WSU) shunt biobank. METHODS: To date, four hospital centers have contributed various components of failed shunts and CSF from patients diagnosed with hydrocephalus before adulthood. The hardware samples are transported in paraformaldehyde and transferred to phosphate-buffered saline with sodium azide upon deposit into the biobank. Once in the bank, they are then available for study. Informed consent is obtained by the local center before corresponding clinical data are entered into a REDCap database. Data such as hydrocephalus etiology and details of shunt revision history. All data are entered under a coded identifier. RESULTS: 293 shunt samples were collected from 228 pediatric patients starting from May 2015 to September 2019. We saw a significant difference in the number of revisions per patient between centers (Kruskal-Wallis H test, p value \u3c 0.001). The leading etiology at all centers was post-hemorrhagic hydrocephalus, a fisher\u27s exact test showed there to be statistically significant differences in etiology between center (p = 0.01). Regression showed age (p \u3c 0.01), race (p = 0.038) and hospital-center (p \u3c 0.001) to explain significant variance in the number of revisions. Our model accounted for 31.9% of the variance in revisions. Generalized linear modeling showed hydrocephalus etiology (p \u3c 0.001), age (p \u3c 0.001), weight and physician (p \u3c 0.001) to impact the number of ventricular obstructions. CONCLUSION: The retrospective analysis identified that differences exist between currently enrolled centers, although further work is needed before clinically actionable recommendations can be made. Moreover, the variables collected from this chart review explain a meaningful amount of variance in the number of revision surgeries. Future work will expand on the contribution of different site-specific and patient-specific factors to identify potential cause and effect relationships