Test characteristics of neuroimaging in the emergency department evaluation of children for cerebrospinal fluid shunt malfunction
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 characteristi...
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| Veröffentlicht in: | Canadian journal of emergency medicine 2008-03, Vol.10 (2), p.131-135 |
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| creator | Mater, Ahmed Shroff, Manohar Al-Farsi, Sami Drake, James Goldman, Ran D. |
| description | 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.
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.
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.
Neuroimaging has a low sensitivity for identifying shunt malfunction. Neurosurgical consultation should be sought if shunt malfunction is clinically suspected, despite normal imaging. |
| doi_str_mv | 10.1017/S1481803500009842 |
| format | Article |
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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.
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.
Neuroimaging has a low sensitivity for identifying shunt malfunction. Neurosurgical consultation should be sought if shunt malfunction is clinically suspected, despite normal imaging.</description><identifier>ISSN: 1481-8035</identifier><identifier>EISSN: 1481-8043</identifier><identifier>DOI: 10.1017/S1481803500009842</identifier><identifier>PMID: 18371251</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Adolescent ; Brain Diseases - diagnostic imaging ; Brain Diseases - etiology ; Care and treatment ; Cerebrospinal Fluid Shunts - adverse effects ; Cerebrospinal Fluid Shunts - instrumentation ; Child ; Child, Preschool ; Children ; Children's hospitals ; Deformities ; Diagnosis, Differential ; Diagnostic imaging ; Emergency medical care ; Emergency medicine ; Emergency service ; Equipment Failure ; Female ; Head ; Hospitals ; Humans ; Imaging systems ; Infant ; Intensive Care Units, Pediatric - statistics & numerical data ; Male ; Medical imaging ; Medical research ; Medicine, Experimental ; Original Research • Recherche originale ; Patients ; Pediatric EM ; Pediatrics ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed - methods ; X-rays</subject><ispartof>Canadian journal of emergency medicine, 2008-03, Vol.10 (2), p.131-135</ispartof><rights>Copyright © Canadian Association of Emergency Physicians 2008</rights><rights>COPYRIGHT 2008 Decker Publishing</rights><rights>Copyright Canadian Medical Association Mar 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c551t-cd081ffe28f235d6f3a59fc652e1bf9e45680b013a1de6ebb4509749050325b33</citedby><cites>FETCH-LOGICAL-c551t-cd081ffe28f235d6f3a59fc652e1bf9e45680b013a1de6ebb4509749050325b33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18371251$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mater, Ahmed</creatorcontrib><creatorcontrib>Shroff, Manohar</creatorcontrib><creatorcontrib>Al-Farsi, Sami</creatorcontrib><creatorcontrib>Drake, James</creatorcontrib><creatorcontrib>Goldman, Ran D.</creatorcontrib><title>Test characteristics of neuroimaging in the emergency department evaluation of children for cerebrospinal fluid shunt malfunction</title><title>Canadian journal of emergency medicine</title><addtitle>Can J Emergen Med</addtitle><description>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.
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.
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.
Neuroimaging has a low sensitivity for identifying shunt malfunction. Neurosurgical consultation should be sought if shunt malfunction is clinically suspected, despite normal imaging.</description><subject>Adolescent</subject><subject>Brain Diseases - diagnostic imaging</subject><subject>Brain Diseases - etiology</subject><subject>Care and treatment</subject><subject>Cerebrospinal Fluid Shunts - adverse effects</subject><subject>Cerebrospinal Fluid Shunts - instrumentation</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Children's hospitals</subject><subject>Deformities</subject><subject>Diagnosis, Differential</subject><subject>Diagnostic imaging</subject><subject>Emergency medical care</subject><subject>Emergency medicine</subject><subject>Emergency service</subject><subject>Equipment Failure</subject><subject>Female</subject><subject>Head</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Imaging systems</subject><subject>Infant</subject><subject>Intensive Care Units, Pediatric - statistics & numerical data</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Original Research • Recherche originale</subject><subject>Patients</subject><subject>Pediatric EM</subject><subject>Pediatrics</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>X-rays</subject><issn>1481-8035</issn><issn>1481-8043</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kktv1DAUhSMEomXgB7BBFgskFil2HOexrCoelSpYtKwtx7nOuHLs1A9El_3ndTQj2oFiL2xdfefIPvcWxVuCTwgm7adLUnekw5ThvPqurp4Vx2up7HBNn_-5U3ZUvArhGmNSMdK9LI5IR9v1flzcXUGISG6FFzKC1yFqGZBTyELyTs9i0nZC2qK4BQQz-AmsvEUjLMLHGWxE8EuYJKJ2dpXJrTajB4uU80iCh8G7sGgrDFIm6RGFbcqiWRiVrFxVr4sXSpgAb_bnpvj55fPV2bfy4sfX87PTi1IyRmIpR9wRpaDqVEXZ2CgqWK9kwyogg-qhZk2HB0yoICM0MAw1w31b95hhWrGB0k3xYee7eHeT8q_5rIMEY4QFlwJvcV1jltPaFO__Aq9d8vkHgZOetT1pWpKhcgdNwgDXVrmYE8zhgBfGWVA6l09J2zT5BR19MD3g5aJv-GPo5Ako7xFmLZ90_XggyEyE33ESKQR-fvn9kCU7VuaOBA-KLz73199ygvk6Tvyfccqad_so0jDD-KDYz08G6N5UzIPX4wSPwvqv7T0vfdOh</recordid><startdate>20080301</startdate><enddate>20080301</enddate><creator>Mater, Ahmed</creator><creator>Shroff, Manohar</creator><creator>Al-Farsi, Sami</creator><creator>Drake, James</creator><creator>Goldman, Ran D.</creator><general>Cambridge University Press</general><general>Decker Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ISN</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>8FV</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M3G</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20080301</creationdate><title>Test characteristics of neuroimaging in the emergency department evaluation of children for cerebrospinal fluid shunt malfunction</title><author>Mater, Ahmed ; Shroff, Manohar ; Al-Farsi, Sami ; Drake, James ; Goldman, Ran D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c551t-cd081ffe28f235d6f3a59fc652e1bf9e45680b013a1de6ebb4509749050325b33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Brain Diseases - 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Academic</collection><jtitle>Canadian journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mater, Ahmed</au><au>Shroff, Manohar</au><au>Al-Farsi, Sami</au><au>Drake, James</au><au>Goldman, Ran D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Test characteristics of neuroimaging in the emergency department evaluation of children for cerebrospinal fluid shunt malfunction</atitle><jtitle>Canadian journal of emergency medicine</jtitle><addtitle>Can J Emergen Med</addtitle><date>2008-03-01</date><risdate>2008</risdate><volume>10</volume><issue>2</issue><spage>131</spage><epage>135</epage><pages>131-135</pages><issn>1481-8035</issn><eissn>1481-8043</eissn><abstract>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.
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.
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.
Neuroimaging has a low sensitivity for identifying shunt malfunction. Neurosurgical consultation should be sought if shunt malfunction is clinically suspected, despite normal imaging.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>18371251</pmid><doi>10.1017/S1481803500009842</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Brain Diseases - diagnostic imaging Brain Diseases - etiology Care and treatment Cerebrospinal Fluid Shunts - adverse effects Cerebrospinal Fluid Shunts - instrumentation Child Child, Preschool Children Children's hospitals Deformities Diagnosis, Differential Diagnostic imaging Emergency medical care Emergency medicine Emergency service Equipment Failure Female Head Hospitals Humans Imaging systems Infant Intensive Care Units, Pediatric - statistics & numerical data Male Medical imaging Medical research Medicine, Experimental Original Research • Recherche originale Patients Pediatric EM Pediatrics Reproducibility of Results Retrospective Studies Sensitivity and Specificity Tomography, X-Ray Computed - methods X-rays |
| title | Test characteristics of neuroimaging in the emergency department evaluation of children for cerebrospinal fluid shunt malfunction |
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