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Objective <p>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 (&gt; 14&#xa0;days) in pediatric PMH.</p> Methods <p>A retrospective cohort study was conducted at a tertiary care center between January 2024 and December 2025. Children aged ≤ 12&#xa0;years with PMH managed via Ommaya reservoir were included. Delayed clearance was defined as more than 14&#xa0;days to achieve two sterile CSF cultures taken ≥ 48&#xa0;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.</p> Results <p>Among 37 patients (median age 5&#xa0;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&#xa0;mg/dL (OR 1.005 per mg/dL; p = 0.038), and age &lt; 5&#xa0;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,&#xa0;exploratory univariate logistic regression was performed in the subset of patients with available data.</p> Conclusions <p>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.</p>

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A multivariate prediction model to predict delayed CSF sterilization in paediatric post-meningitic hydrocephalus

  • 期刊论文

  • 发表日期：

    2026年4月1日

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  • Mohsin Fayaz,
  • Aizul Khursheed,
  • Vishal Chavda,
  • Abrar Ahad Wani,
  • Sarabjit Singh Chibber,
  • Feroze Ahmad Mir,
  • Nayil Khursheed Malik,
  • Sajad Hussain Arif

摘要

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.