Childs Nerv Syst. 2026 Apr 1;42(1):144. doi: 10.1007/s00381-026-07235-7.
ABSTRACT
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.
PMID:41917470 | DOI:10.1007/s00381-026-07235-7
