Signs and Symptoms of Cerebrospinal Fluid Shunt Malfunction in the Pediatric Emergency Department

Kim, Tommy Y.; Stewart, Gail; Voth, M.H.; Moynihan, James A.; Brown, Lance

doi:10.1097/01.pec.0000195764.50565.8c

Cited by 55 publications

(34 citation statements)

References 24 publications

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“…Se estima que entre 25 y 46% de las derivaciones tienen un mal funcionamiento durante el primer año después de haber sido instaladas 4,5 , siendo la obstrucción mecánica y las infecciones, las dos principales causas de disfunción valvular 6,7 . La tasa de infección post instalación de DVP en la población infantil se estima en 10% y fl uctúa entre 0 y 22% [8][9][10][11] , siendo una causa importante de morbimortalidad 12 .…”

Section: Correspondencia Aunclassified

Factores de riesgo de infección de derivativa ventrículo peritoneal en pacientes pediátricos del Hospital Carlos Van Buren

et al. 2012

Rev. chil. infectol.

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Hydrocephalus is a common problem in Neurosurgery and Neurology. The usual treatment is the installation of a Ventricular Peritoneal Shunt (VPS). Infection is the most frequent and serious complication. With the aim to identify risk factors associated with infection in the post surgery of VPS in pediatric patients from Carlos Van Buren Hospital a case control study between 1998-2008 was done. Cases were patients with VPS infection reported to the Department of Nosocomial Infections. Results in contingency tables were analyzed to determine Odds Ratio. 264 surgical procedures were studied in 207 patients with 53 infections reported in 26 patients. Signifi cant risk factors were: history of prior ventriculitis, VPS dysfunction and prior external ventricular shunt, concurrent infections at the time of surgery and a neurosurgeon without the specialty of pediatric neurosurgery. We concluded that antibiotic prophylaxis was not an important factor in preventing infection and the neurosurgeon experience is relevant to the development of VPS infections.Key words: VPS, infection, risk factors, ventriculitis, shunt infections. Palabras clave: DVP, infección, factores de riesgo, ventriculitis, infección DVP.Universidad de Valparaíso, Valparaíso, Chile. Facultad de Medicina (APA, RSZ, RVF).Hospital Carlos Van Buren, Valparaíso, Chile. Servicio de Neurocirugía. (RRP, CSZ). Departamento de Control de infecciones (RHO).Los autores declaran no tener conflictos de interés. Fuente de financiamiento:Autónoma. Recibido: 21 de marzo de 2011Aceptado: 13 de octubre de 2011Correspondencia a:Introducción L a hidrocefalia es un problema común en neurología y neurocirugía pediátrica, cuya etiología es un desbalance entre la producción, circulación y reabsorción del líquido cefalorraquídeo (LCR)1 . El desarrollo de esta condición en la infancia es frecuente, siendo secundaria a un grupo variado de patologías cerebrales, entre las cuales destacan: cerebrales congénitas, traumáticas, tumorales, infecciosas y vasculares 2 . Una de las opciones para el tratamiento permanente de esta patología es la inserción de un catéter junto a una válvula que conecte el ventrículo cerebral con una cavidad serosa como el peritoneo 3 o derivativa ventrículo peritoneal (DVP) o con una vena profunda, donde el exceso de LCR pueda ser drenado.Se estima que entre 25 y 46% de las derivaciones tienen un mal funcionamiento durante el primer año después de haber sido instaladas 4,5 , siendo la obstrucción mecánica y las infecciones, las dos principales causas de disfunción valvular 6,7 . La tasa de infección post instalación de DVP en la población infantil se estima en 10% y fl uctúa entre 0 y 22% [8][9][10][11] , siendo una causa importante de morbimortalidad 12 . Las infecciones tempranas son causadas por la microbiota bacteriana introducida al momento de la cirugía, mientras que las tardías corresponden a contaminaciones posteriores 13 . Se han identifi cado diversos factores del paciente y de la atención asociados a una infección de DVP 14 . Entre los factores relac...

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Section: Correspondencia Aunclassified

Factores de riesgo de infección de derivativa ventrículo peritoneal en pacientes pediátricos del Hospital Carlos Van Buren

et al. 2012

Rev. chil. infectol.

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“…3,8,9 To a certain degree, the content of the protocol was arbitrary. Its purpose was to facilitate the physician decision-making process by obtaining imaging studies in a timely fashion.…”

Section: Clinical Pathway Protocolmentioning

confidence: 99%

Effectiveness of a clinical pathway for patients with cerebrospinal fluid shunt malfunction

Chern¹,

Macias

Jea³

et al. 2010

PED

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Object Patients with CSF shunts often present to the emergency department (ED) with suspected shunt malfunction. Timely assessment and treatment are important factors affecting patient outcomes. A protocol was implemented at a tertiary children's hospital ED to expedite the care of these patients. This study evaluated the effectiveness of this protocol. Methods The protocol assigned all patients with CSF shunts into 1 of 3 pathways. If a patient presented with altered mental status, the Cushing triad, acute focal neurological deficit, ongoing seizure activity, or severe dehydration due to emesis, an ED physician was immediately notified (emergency pathway). If a patient presented with emesis, headache, increasing frequency of seizure, or parental concern for shunt malfunction, the patient entered the expedited pathway, and imaging studies were ordered prior to physician evaluation. All other patients entered the default pathway, in which a physician would evaluate the patient before deciding on further workup. Outcomes of interest included measures of timeliness in the ED and clinical outcomes. Comparisons were made between preprotocol and protocol periods and among the 3 pathways. Results The total time to complete both ED physician evaluation and to initiate imaging studies was significantly shorter in the protocol period than in the preprotocol period (104 vs 147 minutes). Similar time saving over the 2 processes was demonstrated comparing expedited and default pathways during the protocol period (95 vs 134 minutes, a 29% difference). Clinically, more patients underwent surgery in the expedited pathway than the default pathway (36% vs 17%), and patients in the expedited pathway had a shorter hospital stay (3.4 ± 0.9 days vs 5.7 ± 4.0 days; p = 0.02). Conclusions An ED-based protocol helped identify patients at risk for shunt failure early in the triage process and shortened the assessment process prior to neurosurgical intervention. Improving the timeliness of care for patients with shunt failure is important because morbidity and mortality associated with shunt failure are time dependent.

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“…One study estimated that an episode of ventricular shunt failure will occur in 85% of patients within 15 years of device insertion 3 with 30%-40% of ventricular shunts failing after the first year of insertion. 4 Kim et al 5 reported a ventricular shunt mortality rate of 2.2%. The clinical diagnosis of shunt malfunction is further complicated by nonspecific clinical signs, which can be attributed to other common pediatric ailments.…”

mentioning

confidence: 99%

“…The clinical diagnosis of shunt malfunction is further complicated by nonspecific clinical signs, which can be attributed to other common pediatric ailments. 5,6 CT evaluation of ventricular size, in conjunction with clinical symptoms, is the primary means of assessing ventricular CSF shunt failure/malfunction in pediatric patients with closed fontanelles. 5 However, concerns were expressed regarding the use of CT in children, 7 primarily because they are more sensitive than adults for some cancers, one of which is radiation-induced brain tumor.…”

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confidence: 99%

Pilot Study of Radiation Dose Reduction for Pediatric Head CT in Evaluation of Ventricular Size

Габриэль

Eckel

DeLone

et al. 2014

AJNR Am J Neuroradiol

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Signs and Symptoms of Cerebrospinal Fluid Shunt Malfunction in the Pediatric Emergency Department

Cited by 55 publications

References 24 publications

Factores de riesgo de infección de derivativa ventrículo peritoneal en pacientes pediátricos del Hospital Carlos Van Buren

Factores de riesgo de infección de derivativa ventrículo peritoneal en pacientes pediátricos del Hospital Carlos Van Buren

Effectiveness of a clinical pathway for patients with cerebrospinal fluid shunt malfunction

Pilot Study of Radiation Dose Reduction for Pediatric Head CT in Evaluation of Ventricular Size

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