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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

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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

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