Emergency Point-of-Care Ultrasound Identification of Pediatric Ventriculoperitoneal Shunt Malfunctions

Shellshear, Deborah; Snelling, Peter J; O’Brien, Adam; Barrett, Michael J.

doi:10.1097/pec.0000000000001372

Cited by 4 publications

(2 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A multicenter, prospective trial investigating presenting symptoms for all patients and in those with negative neuroimaging may be required to better define risk factorsperhaps used in combination with adjunctive diagnostic tests, such as optic nerve sheath diameter ultrasound, which has shown some promise in discriminating patients in shunt failure from those who are not. 19,20 There were a few important limitations to our study. First, it was a retrospective cohort study evaluating patients with VP shunts presenting for emergency care, comparing predictive factors for patients with failure and those without ascertainable through chart review.…”

Section: Discussionmentioning

confidence: 98%

“…Neuroimaging, although imperfect, also continues to be an essential element of this workup, and extended periods of observation may be required to monitor for the evolution of symptoms. A multicenter, prospective trial investigating presenting symptoms for all patients and in those with negative neuroimaging may be required to better define risk factors—perhaps used in combination with adjunctive diagnostic tests, such as optic nerve sheath diameter ultrasound, which has shown some promise in discriminating patients in shunt failure from those who are not 19,20 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Variables Associated With Shunt Failure in Children With Cerebrospinal Fluid Diverting Shunts

Burns¹,

Tanski²,

Heilman³

et al. 2021

Pediatr Emer Care

View full text Add to dashboard Cite

Pediatric patients with shunted hydrocephalus are frequently evaluated in the emergency department (ED) with concern for shunt failure. Because shunt failure is potentially life-threatening, accurate diagnosis is essential. However, neuroimaging imperfectly detects children in failure, with reported sensitivities of 53% to 92% for computed tomography and 51% to 59% for magnetic resonance imaging.Objectives: We sought to identify clinical characteristics that would negatively predict shunt failure, thus potentially obviating the need for further diagnostic workup or extended periods of observation. We hypothesized that viral symptoms and a patient history of epilepsy or chronic headaches would be negative predictors of shunt failure.Methods: Data were retrospectively collected for children 19 years or younger with a cerebrospinal fluid diverting shunt in their medical history or problem list who underwent neuroimaging during an ED visit from March 2008 to September 2016. Patients were defined as having shunt failure if they required surgical exploration for shunt revision within 7 days of the ED visit. Descriptive statistics were used for patient demographics, current symptoms, and historical features. We conducted a logistic regression analysis to determine which characteristics were associated with the odds of shunt failure and used binary recursive partitioning to determine if there were features or a combination of features that were able to accurately classify patients without shunt failure.Results: There were 606 visits by 277 patients during this interval, 34% of whom were experiencing shunt failure. Variables found to be significantly predictive of shunt failure were revision within the prior 6 months, vomiting, personality changes, family opinion of shunt failure, and cranial nerve palsies. Viral symptoms and a history of epilepsy or chronic headaches were not predictive of shunt failure. Binary recursive partitioning identified family opinion and personality changes as predictive of shunt failure, with a sensitivity of 72.2% (95% confidence interval, 65.5%-78.2%) and specificity of 46.6% (95% confidence interval, 41.7%-51.7%).Conclusions: Although certain clinical and historical features have modest predictive value in children with shunted hydrocephalus, these factors are insufficiently sensitive to exclude shunt failure, arguing for liberal neuroimaging and extended observation.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Variables Associated With Shunt Failure in Children With Cerebrospinal Fluid Diverting Shunts

Burns¹,

Tanski²,

Heilman³

et al. 2021

Pediatr Emer Care

View full text Add to dashboard Cite

show abstract

Radiation safety education and diagnostic imaging in pediatric patients with surgically treated hydrocephalus: the patient and family perspective

et al. 2020

View full text Add to dashboard Cite

Shunt Fractures Associated with Intermittent Hydrocephalus: Case Reviews and New Solutions

Yakar

Kaya

2022

World Neurosurgery

View full text Add to dashboard Cite

Emergency Point-of-Care Ultrasound Identification of Pediatric Ventriculoperitoneal Shunt Malfunctions

Abstract: Ventriculoperitoneal shunt malfunctions should be accurately and efficiently diagnosed. In this case series, we describe the use of point-of-care ultrasound to rapidly identify pediatric ventriculoperitoneal shunt tubing fracture, obstruction, and infection.

Cited by 4 publications

References 14 publications

Variables Associated With Shunt Failure in Children With Cerebrospinal Fluid Diverting Shunts

Variables Associated With Shunt Failure in Children With Cerebrospinal Fluid Diverting Shunts

Radiation safety education and diagnostic imaging in pediatric patients with surgically treated hydrocephalus: the patient and family perspective

Shunt Fractures Associated with Intermittent Hydrocephalus: Case Reviews and New Solutions

Contact Info

Product

Resources

About