Evidence map›Paper›PMID 37470933›Full record

ArticleNeurocritical care2024

Pediatric Moyamoya Revascularization Perioperative Care: A Modified Delphi Study.

Lisa R Sun, Lori C Jordan, Edward R Smith, Philipp R Aldana, Matthew P Kirschen, Kristin Guilliams, Nalin Gupta, Gary K Steinberg, Christine Fox, Dana B Harrar and 21 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in Neurocritical care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 pooled it
4.5field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
  5. Article
  6. Article
  7. Article
  8. Review
  9. Article
  10. Relative anemia and perioperative stroke in children with moyamoya.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2024
    Article
  11. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

31 authors at 20 institutions in 2 countries.

Lisa R SunDivision of Cerebrovascular Neurology, Division of Pediatric Neurology, The Johns Hopkins School of Medicine, Baltimore, MD, USA. Lsun20@jhmi.edu.ORCID 0000-0003-4948-0415
Lori C JordanDepartment of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
Edward R SmithDepartment of Neurosurgery, Boston Children's Hospital, Boston, MA, USA.
Philipp R AldanaDivision of Pediatric Neurosurgery, University of Florida College of Medicine, Section of Neurosurgery, Wolfson Children's Hospital, Jacksonville, FL, USA.
Matthew P KirschenDepartments of Anesthesiology and Critical Care Medicine, Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Kristin GuilliamsDepartments of Neurology, Pediatrics, and Radiology, Washington University School of Medicine, St. Louis, MO, USA.
Nalin GuptaDepartments of Neurological Surgery and Pediatrics, University of California, San Francisco, CA, USA.
Gary K SteinbergDepartment of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
Christine FoxDepartment of Neurology, University of California, San Francisco, CA, USA.
Dana B HarrarDivision of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
Sarah LeeDivision of Child Neurology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Melissa G ChungDepartment of Pediatrics, Divisions of Pediatric Neurology and Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Peter DirksDivision of Neurosurgery, The Hospital for Sick Children, Toronto, Canada.
Nomazulu DlaminiDivision of Neurology, The Hospital for Sick Children, Toronto, Canada.
Cormac O MaherDepartment of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
Laura L LehmanDepartment of Neurology, Boston Children's Hospital, Boston, MA, USA.
Sue J HongDepartment of Pediatrics, Divisions of Critical Care and Child Neurology, Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Jennifer M StrahleDepartment of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA.
Jose A PinedaDepartment of Critical Care, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
Lauren A BeslowDivision of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Lindsey RasmussenDepartment of Critical Care, Stanford University School of Medicine, Stanford, CA, USA.
Janette MailoDivision of Pediatric Neurology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Joseph PiattDivision of Neurosurgery, Nemours Children's Hospital Delaware, Wilmington, DE, USA.
Shih-Shan LangDivision of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
P David AdelsonDepartment of Neurosurgery, WVU Medicine and WVU Medicine Children's Hospital, Morgantown, WV, USA.
Michael C DewanDepartment of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Aleksandra MineykoDepartment of Pediatrics, Section on Neurology, University of Calgary, Calgary, AB, Canada.
Samuel McClugageDepartment of Neurosurgery, Texas Children's Hospital, Houston, TX, USA.
Sudhakar VadiveluDivision of Pediatric Neurosurgery and Interventional Neuroradiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Michael M DowlingDepartments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
David S HershDivision of Neurosurgery, Connecticut Children's, Hartford, CT, USA.
Stanford University · USChildren's Hospital of Philadelphia · USBoston Children's Hospital · USHospital for Sick Children · CAUniversity of California, San Francisco · USVanderbilt University Medical Center · USWashington University in St. Louis · USChildren's Hospital of Los Angeles · USCincinnati Children's Hospital Medical Center · USConnecticut Children's Medical Center · USGeorge Washington University · USJohns Hopkins University · USLurie Children's Hospital · USNationwide Children's Hospital · USTexas Children's Hospital · USThe University of Texas Southwestern Medical Center · USUniversity of Alberta · CAUniversity of Calgary · CAUniversity of Florida · USWest Virginia University Hospitals · US

Funding

VCRC Administration UnitU54NS065705 · NINDS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KIM, HELEN · 2009 to 2023
$20.8M
The Vascular effects of Infection in Pediatric Stroke (VIPS II) StudyR01NS104094 · NINDS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI FULLERTON, HEATHER J · 2017 to 2022
$3.5M
Development of Serum, Imaging, and Clinical Biomarker Driven Models to Direct Clinical Management after Pediatric Cardiac ArrestR01NS096714 · NINDS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI FINK, ERICKA LINN · 2016 to 2020
$2.6M
Cerebral autoregulation and MRI measures of brain injury after pediatric-post cardiac arrestK23NS116120 · NINDS · CHILDREN'S HOSP OF PHILADELPHIA · PI KIRSCHEN, MATTHEW P · 2021 to 2025
$966k
Mentoring in Patient-Oriented Research focused on Neurological Complications of Sickle Cell DiseaseK24HL147017 · NHLBI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI JORDAN, LORI CHAFFIN · 2019 to 2023
$547k
NHLBI NIH HHS K24 HL147017NINDS NIH HHS K23 NS116120NINDS NIH HHS R01 NS096714NINDS NIH HHS R01 NS104094NINDS NIH HHS U54 NS065705
6 · The paper itself

Abstract

backgroundSurgical revascularization decreases the long-term risk of stroke in children with moyamoya arteriopathy but can be associated with an increased risk of stroke during the perioperative period. Evidence-based approaches to optimize perioperative management are limited and practice varies widely. Using a modified Delphi process, we sought to establish expert consensus on key components of the perioperative care of children with moyamoya undergoing indirect revascularization surgery and identify areas of equipoise to define future research priorities.

methodsThirty neurologists, neurosurgeons, and intensivists practicing in North America with expertise in the management of pediatric moyamoya were invited to participate in a three-round, modified Delphi process consisting of a 138-item practice patterns survey, anonymous electronic evaluation of 88 consensus statements on a 5-point Likert scale, and a virtual group meeting during which statements were discussed, revised, and reassessed. Consensus was defined as ≥ 80% agreement or disagreement.

resultsThirty-nine statements regarding perioperative pediatric moyamoya care for indirect revascularization surgery reached consensus. Salient areas of consensus included the following: (1) children at a high risk for stroke and those with sickle cell disease should be preadmitted prior to indirect revascularization; (2) intravenous isotonic fluids should be administered in all patients for at least 4 h before and 24 h after surgery; (3) aspirin should not be discontinued in the immediate preoperative and postoperative periods; (4) arterial lines for blood pressure monitoring should be continued for at least 24 h after surgery and until active interventions to achieve blood pressure goals are not needed; (5) postoperative care should include hourly vital signs for at least 24 h, hourly neurologic assessments for at least 12 h, adequate pain control, maintaining normoxia and normothermia, and avoiding hypotension; and (6) intravenous fluid bolus administration should be considered the first-line intervention for new focal neurologic deficits following indirect revascularization surgery.

conclusionsIn the absence of data supporting specific care practices before and after indirect revascularization surgery in children with moyamoya, this Delphi process defined areas of consensus among neurosurgeons, neurologists, and intensivists with moyamoya expertise. Research priorities identified include determining the role of continuous electroencephalography in postoperative moyamoya care, optimal perioperative blood pressure and hemoglobin targets, and the role of supplemental oxygen for treatment of suspected postoperative ischemia.

Indexed as

Cerebral RevascularizationMoyamoya DiseaseStrokeChildDelphi TechniqueHumansPerioperative CarePostoperative CareRetrospective StudiesTreatment OutcomeCerebral revascularizationChildrenDelphi techniqueIschemic strokeMoyamoya diseasePediatric strokePerioperative care

Identifiers

PMID37470933
PMCPMC11023720
OpenAlexW4384820728

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.