A decision tree to guide long term venous access placement in children and adolescents undergoing surgery for renal tumors.
BACKGROUND/PURPOSE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: These preliminary data support the continued study of this VADT to guide intraoperative decisions regarding VA placement in patients with renal tumors.
LEVEL OF EVIDENCE: III - Study of diagnostic test.
Journal of pediatric surgery
Adolescent; Catheterization; Child; Child, Preschool; Decision Trees; Humans; Infant; Kidney; Kidney Neoplasms; Retrospective Studies
Kidney tumors; Mediport; Pediatric oncology; Renal tumors; Venous access
Saltzman, A. F., Carrasco, A., Hecht, S., Walker, J., Caldwell, B. T., Bruny, J. L., Cost, N. G. A decision tree to guide long term venous access placement in children and adolescents undergoing surgery for renal tumors. Journal of pediatric surgery 55, 1334-1338 (2020).