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A decision tree to guide long term venous access placement in children and adolescents undergoing surgery for renal tumors
- Source :
- Journal of Pediatric Surgery. 55:1334-1338
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- While many children with renal tumors require long term venous access (VA) for adjuvant chemotherapy, certainly not all do. This study develops and tests a VA decision tree (DT) to direct the placement of VA in patients with renal tumors.Utilizing data readily available at surgery a VADT was developed. The VADT was tested retrospectively by 2 independent reviewers on a historic cohort. The ability of the VADT to appropriately select which patients would benefit from VA placement was tested.160 patients underwent renal tumor surgery between 2005 and 2018. 70 (43.8%) patients met study criteria with median age of 45.1 months (range 1.1-224); 73% required VA. Using the VADT, VA placement was "needed" in 67.1% of patients and "deferred" in 32.9%. Interrater reliability was very high (kappa = 0.97, 95% CI 0.91-1, p 0.001). The sensitivity and specificity of the VADT to correctly decide on VA placement were 0.92 (0.8-0.98) and 1 (0.79-1). Using the VADT, no patient would have undergone unnecessary VA placement. In reality, 4.3% of patients had an unnecessary VA placed which required a subsequent removal.These preliminary data support the continued study of this VADT to guide intraoperative decisions regarding VA placement in patients with renal tumors.III - Study of diagnostic test.
- Subjects :
- medicine.medical_specialty
Adolescent
Adjuvant chemotherapy
Kidney
Catheterization
03 medical and health sciences
0302 clinical medicine
030225 pediatrics
Pediatric oncology
medicine
Humans
In patient
Child
Retrospective Studies
business.industry
Decision Trees
Infant
Diagnostic test
General Medicine
Evidence-based medicine
Renal tumor
Kidney Neoplasms
Surgery
Venous access
Child, Preschool
030220 oncology & carcinogenesis
Pediatrics, Perinatology and Child Health
Cohort
business
Subjects
Details
- ISSN :
- 00223468
- Volume :
- 55
- Database :
- OpenAIRE
- Journal :
- Journal of Pediatric Surgery
- Accession number :
- edsair.doi.dedup.....dbeda31e1aa6becf9cfa12804d6c1e89