Predicting shunt failure on the basis of clinical symptoms and signs in children

Update item information
Publication Type Journal Article
School or College School of Medicine
Department Neurosurgery
Creator Kestle, John R. W.
Other Author Garton, Hugh J. L.; Drake, James M.
Title Predicting shunt failure on the basis of clinical symptoms and signs in children
Date 2001
Description Object. In evaluating pediatric patients for shunt malfunction, predictive values for symptoms and signs are important in deciding which patients should undergo an imaging study, whereas determining clinical findings that correlate with a low probability of shunt failure could simplify management. Methods. Data obtained during the recently completed Pediatric Shunt Design Trial (PSDT) were analyzed. Predictive values were calculated for symptoms and signs of shunt failure. To refine predictive capability, a shunt score based on a cluster of signs and symptoms was derived and validated using multivariate methods. Four hundred thirty-one patient encounters after recent shunt insertions were analyzed. For encounters that took place within 5 months after shunt insertion (early encounters), predictive values for symptoms and signs included the following: nausea and vomiting (positive predictive value [PPV] 79%, likelihood ratio [LR] 10.4), irritability (PPV 78%, LR 9.8), decreased level of consciousness (LOC) (PPV 100%), erythema (PPV 100%), and bulging fontanelle (PPV 92%, LR 33.1). Between 9 months and 2 years after shunt insertion (late encounters), only loss of developmental milestones (PPV 83%, LR 36.7) and decreased LOC (PPV 100%) were strongly associated with shunt failure. However, the absence of a symptom or sign still left a 15 to 29% (early encounter group) or 9 to 13% (late encounter group) chance of shunt failure. Using the shunt score developed for early encounters, which sums from 1 to 3 points according to the specific symptoms or signs present, patients with scores of 0, 1, 2, and 3 or greater had shunt failure rates of 4%, 50%, 75%, and 100%, respectively. Using the shunt score derived from late encounters, patients with scores of 0, 1, and 2 or greater had shunt failure rates of 8%, 38%, and 100%, respectively. Conclusions. In children, certain symptoms and signs that occur during the first several months following shunt insertion are strongly associated with shunt failure; however, the individual absence of these symptoms and signs offers the clinician only a limited ability to rule out a shunt malfunction. Combining them in a weighted scoring system improves the ability to predict shunt failure based on clinical findings.
Type Text
Publisher American Association of Neurological Surgeons (AANS)
Volume 94
Issue 2
First Page 202
Last Page 210
Subject Pediatric Shunt Design Trial; PSDT; Shunt failure; Shunt malfunction; Clinical signs
Subject LCSH Cerebrospinal fluid shunts; Symptoms
Language eng
Bibliographic Citation Garton, H. J. L., Kestle, J. R. W. & Drake, J. M. (2001). Predicting shunt failure on the basis of clinical symptoms and signs in children. Journal of Neurosurgery, 94(2), 202-10.
Rights Management (c) American Association of Neurological Surgeons
Format Medium application/pdf
Format Extent 67,494 bytes
Identifier ir-main,13182
ARK ark:/87278/s6474vdd
Setname ir_uspace
Date Created 2012-06-13
Date Modified 2012-06-13
ID 706365
Reference URL https://collections.lib.utah.edu/ark:/87278/s6474vdd
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