Conventional clinical signs and symptoms are poor predictors of postoperative cerebrospinal fluid leak: A single-centre cohort perspective

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY Clinical Otolaryngology Pub Date : 2024-05-22 DOI:10.1111/coa.14179

Jonathan C. Pang, Leo L. T. Meller, Cecilia H. Nguyen, Arash Abiri, Dean D. Chung, Theodore V. Nguyen, Benjamin F. Bitner, Frank P. K. Hsu, Edward C. Kuan

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Abstract

Background

Postoperative cerebrospinal fluid (CSF) leak remains a concerning complication of the endoscopic endonasal approach (EEA) for skull base pathology. Signs and symptoms suggesting CSF leak often trigger additional workup during the postoperative course. We systematically evaluate associations between subjectively reported clinical signs/symptoms noted during the immediate postoperative period and incidence of postoperative CSF leaks.

Methods

Retrospective chart review was conducted at a tertiary academic medical centre including 137 consecutive patients with intraoperative CSF leak during EEA with primary repair between July 2018 and August 2022. Postoperative CSF leak associations with clinical signs and symptoms were evaluated using positive (PPV) and negative predictive values (NPV), sensitivity, specificity and odds ratio (OR) via univariate logistic regression.

Results

Seventy-nine patients (57.7%) had high-flow leaks repaired and 5 (3.6%) developed CSF leaks postoperatively. Of reported symptoms, rhinorrhea was most common (n = 52, 38.0%; PPV [95% CI] = 7.6% [4.8%, 11.9%]), followed by severe headache (n = 47, 34.3%; 6.3% [3.1%, 12.5%]), dizziness (n = 43, 31.4%; 2.3% [0.4%, 12.1%]), salty or metallic taste (n = 20, 14.6%; 9.9% [3.3%, 25.8%]), and throat drainage (n = 10, 7.3%; 9.9% [1.7%, 41.4%]). Nausea or vomiting constituted the most reported sign concerning for CSF leak (n = 73, 53.3%; PPV [95% CI] = 4.1% [2.0%, 8.1%]). On univariate regression, no sign or symptom, including rhinorrhea (OR [95% CI] = 7.00 [0.76–64.44]), throat drainage (3.42 [0.35–33.86]), salty/metallic taste (4.22 [0.66–27.04]), severe headache (3.00 [0.48–18.62]), dizziness (0.54 [0.06–4.94]), fever (3.16 [0.50–19.99]), and nausea/vomiting (1.33 [0.22–8.21]), associated with postoperative CSF leak.

Conclusions

A range of subjectively reported symptoms and signs failed to predict postoperative CSF leak. Further investigation is warranted to inform appropriate attention and response.

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传统的临床症状和体征无法预测术后脑脊液漏：单中心队列视角。

背景：术后脑脊液（CSF）漏仍然是内窥镜鼻内入路（EEA）治疗颅底病变的一个令人担忧的并发症。提示 CSF 漏的体征和症状往往会在术后引发额外的检查。我们系统地评估了术后初期主观报告的临床体征/症状与术后脑脊液漏发生率之间的关系：2018年7月至2022年8月期间，我们在一家三级学术医疗中心进行了回顾性病历审查，包括137例EEA术中CSF漏的连续患者。通过单变量逻辑回归，使用阳性预测值（PPV）和阴性预测值（NPV）、敏感性、特异性和几率比（OR）评估术后 CSF 漏与临床体征和症状的关联：79名患者（57.7%）修复了高流量渗漏，5名患者（3.6%）术后出现脑脊液渗漏。在报告的症状中，鼻出血最常见（n = 52，38.0%；PPV [95% CI] = 7.6% [4.8%, 11.9%]），其次是严重头痛（n = 47，34.3%；6.3% [3.1%, 12.5%]）、头晕（43 人，占 31.4%；2.3% [0.4%，12.1%]）、咸味或金属味（20 人，占 14.6%；9.9% [3.3%，25.8%]）和喉咙分泌物（10 人，占 7.3%；9.9% [1.7%，41.4%]）。恶心或呕吐是报告最多的有关 CSF 泄漏的体征（n = 73，53.3%；PPV [95% CI] = 4.1% [2.0%，8.1%]）。在单变量回归中，没有任何体征或症状，包括鼻出血（OR [95% CI] = 7.00 [0.76-64.44]）、咽喉流脓（3.42 [0.35-33.86]）、咸味/金属味（4.22 [0.66-27.04]）、剧烈头痛（3.00 [0.48-18.62]）、头晕（0.54 [0.06-4.94]）、发热（3.16 [0.50-19.99]）和恶心/呕吐（1.33 [0.22-8.21]）：结论：一系列主观报告的症状和体征无法预测术后 CSF 漏。结论：一系列主观报告的症状和体征并不能预测术后 CSF 渗漏，因此有必要进行进一步调查，以提供适当的注意事项和应对措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.