目的:通常建议对脑积水患者进行长期随访,但是临床随访的频率,成像的时间和模式,和监测的持续时间尚未明确定义。这里,作者使用改进的德尔菲法来确定关于模态的共识领域,频率,和手术治疗后脑积水监测的持续时间。
方法:小儿神经外科医生作为脑积水临床研究网络(HCRN)的机构联络人,或其实施/质量改进部门(HCRNq),被邀请参加这项改良的德尔福研究。通过匿名电子调查产生并分发了37份共识声明,回答结构为4点李克特量表(强烈同意,同意,不同意,强烈反对)。随后,虚拟会议提供了公开讨论和修改声明的机会,以达成共识(定义为≥80%的同意或分歧)。
结果:19名小儿神经外科医生参加了第一轮,之后,15项声明达成共识。在第二轮中,14名与会者实际上开会进行审查和讨论。修改了部分语句,合并了2条语句,共产生36个陈述。在会议结束时,就以下17项陈述达成共识:1)标准化的作用;2)首选的成像方式;3)分流手术后的术后随访(细分为术后即刻成像,术后延迟成像,常规临床监测,和常规放射学监测);4)内镜下第三脑室造口术后的术后随访。19项声明未能达成共识。
结论:使用改进的德尔菲法,关于分流术或内窥镜第三脑室造口术后的临床和放射学随访,得出了17个共识声明。频率,模态,并解决了监视的持续时间,强调没有明确数据指导临床实践的领域。尽管需要进一步的研究来评估脑积水监测的临床效用和成本效益,本研究提供了一个框架,以指导今后为脑积水患者术后监测制定标准化临床方案的工作.最终,脑积水监测的标准化有可能改善患者护理并优化医疗资源的使用.
OBJECTIVE: Long-term follow-up is often recommended for patients with hydrocephalus, but the frequency of clinical follow-up, timing and modality of imaging, and duration of surveillance have not been clearly defined. Here, the authors used the modified Delphi method to identify areas of consensus regarding the modality, frequency, and duration of hydrocephalus surveillance following surgical treatment.
METHODS: Pediatric neurosurgeons serving as institutional liaisons to the Hydrocephalus Clinical Research Network (HCRN), or its implementation/quality improvement arm (HCRNq), were invited to participate in this modified Delphi
study. Thirty-seven consensus statements were generated and distributed via an anonymous electronic survey, with responses structured as a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). A subsequent, virtual meeting offered the opportunity for open discussion and modification of the statements in an effort to reach consensus (defined as ≥ 80% agreement or disagreement).
RESULTS: Nineteen pediatric neurosurgeons participated in the first round, after which 15 statements reached consensus. During the second round, 14 participants met virtually for review and discussion. Some statements were modified and 2 statements were combined, resulting in a total of 36 statements. At the conclusion of the session, consensus was achieved for 17 statements regarding the following: 1) the role of standardization; 2) preferred imaging modalities; 3) postoperative follow-up after shunt surgery (subdivided into immediate postoperative imaging, delayed postoperative imaging, routine clinical surveillance, and routine radiological surveillance); and 4) postoperative follow-up after an endoscopic third ventriculostomy. Consensus could not be achieved for 19 statements.
CONCLUSIONS: Using the modified Delphi method, 17 consensus statements were developed with respect to both clinical and radiological follow-up after a shunt or endoscopic third ventriculostomy. The frequency, modality, and duration of surveillance were addressed, highlighting areas in which no clear data exist to guide clinical practice. Although further studies are needed to evaluate the clinical utility and cost-effectiveness of hydrocephalus surveillance, the current
study provides a framework to guide future efforts to develop standardized clinical protocols for the postoperative surveillance of patients with hydrocephalus. Ultimately, the standardization of hydrocephalus surveillance has the potential to improve patient care as well as optimize the use of healthcare resources.