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A multivariate prediction model to predict delayed CSF sterilization in paediatric post-meningitic hydrocephalus
Mohsin Fayaz1, Aizul Khursheed2, Vishal Chavda3
1Department of Neurosurgery, Sher-I- Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India. mohsin.fayaz.bhat@gmail.com.
Insights
A new model predicts delayed cerebrospinal fluid (CSF) clearance in children with post-meningitic hydrocephalus (PMH). Prematurity, Acinetobacter infection, and high CSF protein increase risk, aiding early intervention for better outcomes.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Post-meningitic hydrocephalus (PMH) in children often requires cerebrospinal fluid (CSF) diversion via an Ommaya reservoir.
- Achieving sterile CSF in a timely manner is a significant clinical challenge.
Purpose of the Study:
- To develop and validate a multivariate prediction model for estimating the risk of delayed CSF clearance (defined as >14 days) in pediatric PMH.
- Identify key predictors associated with prolonged CSF infection in this population.
Main Methods:
- Retrospective cohort study of children (≤12 years) with PMH treated with an Ommaya reservoir.
- Multivariate logistic regression analysis to identify independent predictors of delayed CSF clearance (>14 days).
- Model performance assessed using AUC, Hosmer-Lemeshow test, and overall accuracy.
Main Results:
- Delayed CSF clearance occurred in 24.3% of 37 patients.
- Independent predictors identified: prematurity (OR 6.36), Acinetobacter infection (OR 5.58), high CSF protein (OR 1.005 per mg/dL), and younger age (<5 months, OR 0.89 per month).
- The model demonstrated good discrimination (AUC 0.82), calibration (p=0.36), and accuracy (85%).
Conclusions:
- A pilot multivariate prediction model was developed to estimate the risk of delayed CSF clearance in pediatric PMH.
- The model shows promising predictive accuracy.
- Further validation in larger, multicenter prospective studies is warranted.
Objective:
Post-meningitic hydrocephalus (PMH) in children often needs temporary cerebrospinal fluid (CSF) diversion using an Ommaya reservoir. Delayed CSF sterilization remains a critical challenge. This study aimed to develop and validate a multivariate prediction model to estimate the risk of delayed CSF clearance (> 14 days) in pediatric PMH.
Methods:
A retrospective cohort study was conducted at a tertiary care center between January 2024 and December 2025. Children aged ≤ 12 years with PMH managed via Ommaya reservoir were included. Delayed clearance was defined as more than 14 days to achieve two sterile CSF cultures taken ≥ 48 h apart. Multivariate logistic regression identified independent predictors of delayed CSF clearance. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow test, and overall accuracy.
Results:
Among 37 patients (median age 5 months; 51.4% female), delayed CSF clearance occurred in 24.3% (9/37). Independent predictors included prematurity (OR 6.36; p = 0.008), Acinetobacter infection (OR 5.58; p = 0.013), CSF protein ≥ 300 mg/dL (OR 1.005 per mg/dL; p = 0.038), and age < 5 months (OR 0.89 per month; p = 0.045). The model showed good discrimination (AUC 0.82), calibration (p = 0.36), and accuracy (85%). Because CRP and CSF lactate values were unavailable in the full cohort, exploratory univariate logistic regression was performed in the subset of patients with available data.
Conclusions:
In conclusion, we presented a multivariate prediction model as a pilot, internally validated tool designed to estimate the risk of delayed CSF clearance in pediatric post-meningitic hydrocephalus. While the model demonstrated promising predictive accuracy, its findings require confirmation in larger, multicenter prospective studies.
