Implementing a digital real-time Hydrocephalus and Shunt Registry to evaluate contemporary pattern of care and surgical outcome in pediatric hydrocephalus

• Published in: Child's nervous system 2018-03, Vol.34 (3), p.457-464
• Main Authors: Bock, Hans Christoph, Kanzler, Maximilian, Thomale, Ulrich-Wilhelm, Ludwig, Hans Christoph
• Format: Article
• Language: English
• Subjects: Child; Child, Preschool; Computer Systems - trends; Databases, Factual - trends; Female; Follow-Up Studies; Humans; Hydrocephalus - diagnosis; Hydrocephalus - surgery; Infant; Male; Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Original Paper; Prospective Studies; Registries; Retrospective Studies; Treatment Outcome; Ventriculoperitoneal Shunt - methods; Ventriculoperitoneal Shunt - trends
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-017-3654-0

Objective Treatment monitoring and outcome evaluation in pediatric hydrocephalus require gapless documentation regarding surgical and clinical follow-up data beginning from day 1 of treatment in order to apply high quality of care. Endoscopic procedures, shunt insertion and revision surgeries, and individual modifications of valve hardware or pressure settings during follow-up as well as established outcome measurements are highly relevant for complete illustration of the patient’s hydrocephalus histories. A digital tool to capture, organize, and analyze comprehensive treatment-related data was estimated long overdue, consequentially developed, and implemented in daily pediatric neurosurgical routine. Methods We established a self-contained, network-capable database application to supply and back up clinical information of complete surgical treatment history with implant status and follow up for all institutional pediatric hydrocephalus patients from 1995 to date. The application content has been prospectively complemented since 2012 during daily pediatric neurosurgical routine. Beside surgical data, neurological outcome and quality of life assessment were integrated according to validated scales to be recordable 2, 3, and 5 years after initial surgical intervention for prospective administration. The application is in continuous and problem-free use since implementation offering homogeneous and structured real-time information of surgical and corresponding neurological hydrocephalus-related data. By using an automatized data extraction tool, an exemplary surgical outcome evaluation reviewing institutional ventriculo-peritoneal shunt (VPS) treatment in infants over a period of more than 20 years was performed. To validate applicability, the Registry was successfully implemented in an external institution under identical conditions continuously serving for the same purpose until today. Results Upon completion of the developing process, the application was successfully implemented into routine clinical workflow of our institution. In total, 579 pediatric hydrocephalus patients entered into the Registry with collectively 1874 corresponding hydrocephalus-related surgeries (9% neuro-endoscopic procedures, 18% temporary CSF-diversions, 73% shunt surgeries) so far. For exemplary surgical outcome analysis, the total volume of complex data sets could easily be reduced stepwise in regard to requested inclusion criteria. The selection process generated conclusive dat