Faculty Collaboration Database

The Dynamic Gait Index in Evaluating Patients with Normal Pressure Hydrocephalus for Cerebrospinal Fluid Diversion. World Neurosurg 2015 Dec;84(6):1871-6

Date

09/01/2015

Pubmed ID

26320865

DOI

10.1016/j.wneu.2015.08.021

Scopus ID

2-s2.0-84952637653 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

BACKGROUND: Diagnosing normal pressure hydrocephalus (NPH) remains challenging. Most clinical tests currently used to evaluate suspected NPH patients for shunt surgery are invasive, require inpatient admission, and are not without complications. An objective, noninvasive, and low-cost alternative would be ideal.

METHODS: A retrospective review was performed of prospectively collected dynamic gait index (DGI) scores, obtained at baseline and on every day of a 3- to 5-day lumbar cerebrospinal fluid (CSF) drainage trial on patients with suspected NPH at our institution.

RESULTS: Between 2003 and 2014, 170 patients were suspected to have primary NPH (166, 97.6%) or secondary NPH (4, 2.4%). Using responsiveness to lumbar CSF drainage and subsequent shunting as the reference standard, we found that a baseline DGI ≥ 7 was found to have significant ability in selecting patients for permanent CSF diverting shunt surgery: sensitivity of 84.2% (95% confidence interval [95% CI]: 75.6%-90.2%), specificity of 80.6% (95% CI 70.0%-88.0%), and diagnostic odds ratio of 22.1 (95% CI 9.9-49.3).

CONCLUSIONS: A baseline DGI ≥ 7 appears to provide an objective, low-cost, noninvasive measure to select patients with suspected NPH for a positive response to CSF diversion with high sensitivity, specificity and diagnostic odds ratio.

Author List

Chivukula S, Tempel ZJ, Zwagerman NT, Newman WC, Shin SS, Chen CJ, Gardner PA, McDade EM, Ducruet AF

Author

Nathan Zwagerman MD Associate Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Cerebrospinal Fluid Shunts
Dementia
Female
Gait
Humans
Hydrocephalus, Normal Pressure
Male
Middle Aged
Odds Ratio
Predictive Value of Tests
ROC Curve
Retrospective Studies
Sensitivity and Specificity