Is the endoscopic third ventriculostomy success score an appropriate tool to inform clinical decision-making?
BACKGROUND
The endoscopic third ventriculostomy success score (ETVSS) is a model, which provides each patient with a prediction of the outcome of endoscopic third ventriculostomy. The objective of this study was to determine if there is clinical value to the use of the ETVSS in the decision for ETV.


METHODS
Prospectively collected data on all ETV procedures with the Republic of Ireland in children ≤16 years of age, totalling 112, from 2008 to 2014 was analysed. The percentage chance of success at six months was retrospectively calculated according to the ETVSS. A multivariable model, comprising the risk factors from the ETVSS - age, aetiology and previous shunt - was created and its performance compared to that of the ETVSS.


RESULTS
The ETVSS achieved an AUC of 0.61 (95% CI: 0.49-0.71) with a sensitivity and specificity of 50% and 76%, respectively, at its optimal cutoff. The ETVSS was not significantly well calibrated in this cohort and there was a limited net benefit on decision curve analysis in comparison with the strategy of performing ETV in all patients. The multivariable model achieved an AUC of 0.67 (95% CI: 0.56-0.78), was well calibrated and was associated with a superior net benefit over that of the ETVSS.


CONCLUSIONS
The ETVSS represents the future of patient risk stratification with an easy to use, individualised approach for each patient. The ETVSS has performed adequately in this study. However, through the addition of novel risk factors, the continuous updating of the model and recalibration where needed, the ETVSS can become a tool that the paediatric neurosurgeon cannot do without.
a UCD School of Medicine and Medical Science , University College Dublin , Dublin , Ireland.|b Department of Paediatric Neurosurgery , Children's University Hospital , Temple Street , Dublin , Ireland.
R W
http://orcid.org/0000-0002-5457-2392
RW
Foley
b Department of Paediatric Neurosurgery , Children's University Hospital , Temple Street , Dublin , Ireland.
S
S
Ndoro
b Department of Paediatric Neurosurgery , Children's University Hospital , Temple Street , Dublin , Ireland.
D
D
Crimmins
b Department of Paediatric Neurosurgery , Children's University Hospital , Temple Street , Dublin , Ireland.
J
J
Caird
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007494:Ireland; D008297:Male; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods*; D000069471:Neurosurgeons / Q000592:standards; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D020542:Third Ventricle / Q000601:surgery; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods*
Endoscopic third ventriculostomy; clinical prediction modelling; hydrocephalus; paediatric neurosurgery