Hostname: page-component-848d4c4894-cjp7w Total loading time: 0 Render date: 2024-06-26T05:32:08.493Z Has data issue: false hasContentIssue false
  • English
  • Français

Test characteristics of neuroimaging in the emergency department evaluation of children for cerebrospinal fluid shunt malfunction

Published online by Cambridge University Press:  21 May 2015

Ahmed Mater ,
Manohar Shroff ,
Sami Al-Farsi ,
James Drake  and
Ran D. Goldman
Ahmed Mater
Affiliation:
Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ont. Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ont.
Manohar Shroff
Affiliation:
Department of Diagnostic Imaging, University of Toronto, Toronto, Ont.
Sami Al-Farsi
Affiliation:
Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ont.
James Drake
Affiliation:
Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Ont.
Ran D. Goldman*
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, BC. Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ont.
*
Division of Pediatric Emergency Medicine, BC Children's Hospital, Department of Pediatrics, University of British Columbia, Child & Family Research Institute (CFRI), Rm K4-226, Ambulatory Care Building, 4480 Oak St., Vancouver BC V6H 3V4; rgoldman@cw.bc.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Cerebrospinal fluid (CSF) shunt malfunction is one of the most common life-threatening neurosurgical conditions. In the emergency department (ED), imaging techniques to identify shunt malfunction include the shunt series (SS) and CT scanning of the head. We sought to determine the test characteristics of the SS and CT scan for identifying children with shunt malfunction.

Methods:

We retrospectively reviewed the medical records of children with a CSF shunt who presented to our tertiary care pediatric emergency department and received an SS during a 2-year period from Jan. 1, 2001, to Dec. 31, 2002. A pediatric neuroradiologist reviewed all SS and CT scans. We defined shunt malfunction as present if the child underwent operative shunt revision.

Results:

We identified 437 ED visits by 280 children. Forty-seven SS were read as abnormal. A CT scan was performed in 386 (88.3%) cases and 80 were abnormal. Shunt malfunction was identified in 131 (30.0%) children. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of the SS for identifying cases of shunt malfunction were 30.0%, 95.8%, 72.3%, 75.1%, 7.1 and 0.7, respectively; for the CT scan, they were 61.0%, 82.7%, 64.5%, 80.5%, 3.5 and 0.5, respectively.

Conclusion:

Neuroimaging has a low sensitivity for identifying shunt malfunction. Neurosurgical consultation should be sought if shunt malfunction is clinically suspected, despite normal imaging.

Keywords

shunt seriesCT scanhydrocephalusemergency department
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 2 , March 2008 , pp. 131 - 135
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Casey, AT, Kimmings, EJ, Kleinlugtebeld, AD, et al. The long-term outlook for hydrocephalus in childhood: a ten-year cohort study of 155 patients. Pediatr Neurosurg 1997;27:63–70.CrossRefGoogle ScholarPubMed
2.Di Rocco, C, Marchese, E, Velardi, F. A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus: cooperative survey of the 1991–1992 Education Committee of the ISPN. Childs Nerv Syst 1994;10:321–7.Google Scholar
3.Madikians, A, Conway, EE. Cerebrospinal fluid shunt problems in pediatric patients. Pediatr Ann 1997;26:613–20. Google Scholar
4.Madsen, MA. Emergency department management of ventriculoperitoneal cerebrospinal fluid shunts. Ann Emerg Med 1986;15:1330–43.Google Scholar
5.Storrow, AB. Intracranial shunt assessment. In: Roberts, JR, Hedges, JR, editors. Clinical procedures in emergency medicine. 3rd ed. Philadelphia (PA): Saunders Company; 1998. p. 1042–51.Google Scholar
6.Goeser, CD, McLeary, MS, Young, LW. Diagnostic imaging of ventriculoperitoneal shunt malfunctions and complications. Radiographics 1998;18:635–51.Google Scholar
7.Rothrock, SG, Green, SM, Harding, M, et al. Plain abdominal radiography in the detection of acute medical and surgical disease in children: a retrospective analysis. Pediatr Emerg Care 1991;7:281–5.Google Scholar
8.Gilbreath, PL, Mulligan, ME, Sileo, DR. Utilization and cost effectiveness review of shunt series to rule out ventriculoperitoneal shunt malfunction. Emerg Radiol 1999;6:345–9.Google Scholar
9.Zorc, JJ, Krugman, SD, Ogborn, J, et al. Radiographic evaluation for suspected cerebrospinal fluid shunt obstruction. Pediatr Emerg Care 2002;18:337–40.Google Scholar
10.Amacher, AL, Spence, JD. Spectrum of benign intracranial hypertension in children and adolescents. Childs Nerv Syst 1985;1:81–6.Google Scholar
11.Borgesen, SE, Gjerris, F. Relationships between intracranial pressure, ventricular size, and resistance to CSF outflow. J Neurosurg 1987;67:535–9.Google Scholar
12.Fried, A, Shapiro, K. Subtle deterioration in shunted childhood hydrocephalus. A biomechanical and clinical profile. J Neurosurg 1986;65:211–6.Google Scholar
13.Engel, M, Carmel, PW, Chutorian, AM. Increased intraventricular pressure without ventriculomegaly in children with shunts: “normal volume” hydrocephalus. Neurosurgery 1979;5:549–52.Google Scholar
14.Iskandar, BJ, McLaughlin, C, Mapstone, TB, et al. Pitfalls in the diagnosis of ventricular shunt dysfunction: radiology reports and ventricular size. Pediatrics 1998;101:1031–6.Google Scholar
15.Murtagh, FR, Quencer, RM, Poole, CA. Cerebrospinal fluid shunt function and hydrocephalus in the pediatric age group: a radiographic/clinical correlation. Radiology 1979;132:385–8.Google Scholar
16.Watkins, L, Hayward, R, Andar, U, et al. The diagnosis of blocked cerebrospinal fluid shunts: a prospective study of referral to a paediatric neurosurgical unit. Childs Nerv Syst 1994;10:87–90.CrossRefGoogle ScholarPubMed