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• W2108015963 abstract "Source: Garton HJL, Kestle JRW, Drake JM. Predicting shunt failure on the basis of clinical symptoms and signs in children. J Neurosurg. 2001;94:202–210.The diagnosis of cerebrospinal fluid (CSF) shunt failure is difficult even for experienced clinicians because the cardinal symptoms—headache, vomiting, lethargy—are so prevalent in common childhood illnesses such as otitis, gastroenteritis, and various viral syndromes. Pediatricians, parents, and other caretakers must be informed and vigilant, because for each episode of shunt failure the mortality rate is greater than 1%.1 Deaths from shunt failure commonly occur out of hospital despite symptomatic prodromes lasting days to weeks.2To place the recognition of CSF shunt failure on a more scientific footing, this report analyzes clinical data collected prospectively during the recently completed Pediatric Shunt Design Trial.3 A standard battery of clinical data was collected at each scheduled and unscheduled follow-up visit during the trial. The status of the shunt was assessed by the treating neurosurgeon and reviewed by a central adjudication committee using symptoms, signs, and results of imaging studies. In the current study symptoms and signs were tabulated against the final status of the shunt, and each individual factor was analyzed as a test of shunt function. Multivariate logistic regression models were constructed to improve clinical prediction. These models were developed using half of the data set and were validated against the other half.The authors divided the encounters into early (≤ 5 months after surgery; 276 encounters) and late (≥ 9 months after surgery; 155 encounters) groups. The presence of several symptoms and signs in both the early and late groups had strong positive predictive values. For instance, in the early-and late-encounter groups every patient who exhibited papilledema had shunt failure. Unfortunately, no single symptom or sign was reliable in identifying children who did not need further investigation. The multivariate models improved the identification of patients who did not need further investigation (TableT1). The prevalence of shunt failure among patients with scores of 0 was 4% among the early encounters and 8% among the late encounters in the validation data set, whereas a score of only 1 was associated with shunt failure rates of 50% and 38% in the early and late groups, respectively.The “information density” in this report is very high, and interested readers should review the original article. The busy practitioner must have a low threshold for initiating an investigation of a CSF shunt and a low threshold for reassessing symptomatic patients who are not sent initially for investigation. Because the sensitivity of imaging studies in the detection of shunt failure is only about 75%,4 investigation of a CSF shunt should include referral back to the treating neurosurgeon. The possibility of CSF shunt failure should not be dismissed until the suspicious symptoms have resolved or the shunt has been revised.As clinicians, we are eager for any clues that will tell us whom to shunt back to the neurosurgeon, and whom to continue to manage ourselves. Tapping into this study will provide some but not all of these clues." @default.
• W2108015963 created "2016-06-24" @default.
• W2108015963 creator A5007084079 @default.
• W2108015963 date "2001-06-01" @default.
• W2108015963 modified "2023-09-26" @default.
• W2108015963 title "Clinical Recognition of CSF Shunt Failure" @default.
• W2108015963 doi "https://doi.org/10.1542/gr.5-6-56" @default.
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