A decision tree to guide long term venous access placement in children and adolescents undergoing surgery for renal tumors

Amanda F. Saltzman, Alonso Carrasco, Sarah Hecht, Jonathan Walker, Brian T. Caldwell, Jennifer L. Bruny, Nicholas G. Cost

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1334-1338
Number of pages5
JournalJournal of pediatric surgery
Volume55
Issue number7
DOIs
StatePublished - Jul 2020
Externally publishedYes

Keywords

  • Kidney tumors
  • Mediport
  • Pediatric oncology
  • Renal tumors
  • Venous access

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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