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. 2024 Oct 9;166(1):401.
doi: 10.1007/s00701-024-06274-w.

The ASPECT hydrocephalus system: investigating clinical applicability and system utility

N M Toft  1 , S Hornshøj Pedersen  1   2 , T S R Jensen  1   2 , J Birch Milan  1 , C S Riedel  1   3 , N Agerlin  2 , P Birkeland  2 , J Hauerberg  2 , C C Larsen  2 , T N Munch  2 , A Vedel Holst  2 , M Juhler  4   5   6
Affiliations

The ASPECT hydrocephalus system: investigating clinical applicability and system utility

N M Toft et al. Acta Neurochir (Wien). .

Abstract

Purpose: Hydrocephalus presents diagnostic and management challenges due to its heterogeneity. The ASPECT Hydrocephalus System, introduced in 2023, offers a comprehensive approach to describing patients with hydrocephalus. This study investigates the clinical applicability of the ASPECT Hydrocephalus System compared to the International Classification of Disease (ICD-10) and demonstrates its utility.

Methods: Two hundred pediatric and adult patients with hydrocephalus treated at Copenhagen University Hospital between September 2019 and 2020 were described according to the ASPECT Hydrocephalus System. The latest brain imaging served as assessment point.

Results: Forty-seven percent of patients had more than one ICD-10 code assigned, and 40.5% of patients had an unspecific ICD-10 code as the most recent. It was possible to apply factor A (anatomy), S (symptomatology), P (previous interventions), C (complications) and T (time of onset) to all patients. Factor E (etiology) categorized 15% of patients as 'unknown'. Combining factor A and S showed a similar incidence of acute high-pressure symptoms in patients with and without ventriculomegaly on imaging (39.7% vs 39.3%), demonstrating how symptoms and neuro-radiological findings do not necessarily correlate.

Conclusion: The ASPECT Hydrocephalus System's applicability and utility were demonstrated in a large, diverse patient population. Except for 'Etiology', all factors could be applied to the entire population showing the system's robustness. While limitations in ICD-10 may force clinicians to choose between clinical measures, the ASPECT Hydrocephalus System allows comprehensive patient characterization, potentially aiding in clinical decision-making and research. Its use depends on registration quality. Application in prospective cohorts is warranted to assure feasibility.

Keywords: ASPECT Hydrocephalus System; Hydrocephalus.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the patient inclusion process
Fig. 2
Fig. 2
Active ICD-10 codes for patients with one, two or more than two ICD-10 codes. The four most frequent ICD-10 codes of the 106 patients that was assigned only one ICD-10 code was: G91.1 obstructive hydrocephalus (n = 34; 53,2%), G91.9 hydrocephalus, unspecified (n = 30; 54,53%), G94.2 hydrocephalus classified in disease elsewhere (n = 15; 23,94%) and G91.0 communicating hydrocephalus (n = 12; 15,96%). Of the patients assigned more than one ICD-10 code, 29% were assigned two ICD-10 codes, 12% three ICD-10 codes, and 6% four or more ICD-10 codes. Twenty-five of the patients (6%) with more than one ICD-10 code were given G91.9 (hydrocephalus, unspecified) or G91.8 (hydrocephalus other) as the primary ICD code
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