Emergency department evaluation of ventricular shunt malfunction -: Is the shunt series really necessary?
Emergency department evaluation of ventricular shunt malfunction -: Is the shunt series really necessary?
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DOI：
10.1097/pec.0b013e3180328c77
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发表时间：
2007-03-01
影响因子：
1.4
通讯作者：
Pitetti, Raymond
中科院分区：
文献类型：
--
作者：
Pitetti, Raymond
目的：脑室分流故障是小儿神经外科最常见的临床问题之一。对疑似分流器故障的标准急诊科 (ED) 评估包括颅骨、颈部、胸部和腹部（分流器系列）的平片，以查找分流器中的机械断裂、扭结和断开情况，以及颅脑计算机断层扫描 (CT) 扫描，以评估心室大小增大的迹象。然而，我们假设，在头颅 CT 扫描未显示分流故障的情况下，获得分流系列不会被证明在临床上有用。 方法：对所有 18 岁以下、有脑室分流病史的患者进行回顾性图表审查，这些患者在 2000 年 1 月 1 日至 2004 年 9 月 30 日期间因怀疑分流故障而到城市三级儿科急诊室就诊。记录患者的人口统计学和临床特征，以及分流系列和颅脑 CT 扫描的结果。分流故障定义为放射学评估后 1 周内进行分流修复。 结果：在研究期间，291 名患有心室分流的儿童在急诊室接受了 461 次疑似分流故障评估。患者的平均年龄为 90.6 个月（SD，71.5 个月）； 163 名（58.5%）为男性，209 名（71.8%）为白人。 360 名患者 (78.1%) 在 ED 评估期间进行了分流系列，410 名患者 (88.9%) 进行了头部 CT 扫描。 71 名患者 (15.4%) 被诊断为分流故障。 22 人的颅脑 CT 扫描结果正常。在这些患者中，6 例分流系列异常，14 例分流系列正常。结论：在评估疑似分流故障的儿童时，常规使用分流系列似乎是有必要的，因为分流故障儿童的颅脑 CT 扫描可能正常，但分流系列异常。
Objective: The malfunction of a ventricular shunt is one of the most common clinical problems encountered in pediatric neurosurgery. Standard emergency department (ED) evaluation of suspected shunt malfunction consists of plain radiographs of the skull, neck, chest, and abdomen (shunt series) to look for mechanical breaks, kinks, and disconnections in the shunt, and a cranial computed tomography (CT) scan to evaluate for signs of increased ventricular size. We hypothesized, however, that in the context of a cranial CT scan that did not demonstrate a shunt malfunction, obtaining the shunt series would not prove to be clinically useful.Methods: A retrospective chart review was conducted of all patients younger than 18 years with a history of a ventricular shunt who presented to an urban, tertiary pediatric ED between January 1, 2000, and September 30, 2004, for suspected shunt malfunction. Demographic and clinical characteristics of patients were recorded, as well as the results of shunt series and cranial CT scans. Shunt malfunction was defined as the performance of a shunt revision within 1 week of radiographic evaluation.Results: During the study period, 291 children with a ventricular shunt were evaluated in the ED 461 times for suspected shunt malfunction. The mean age of patients was 90.6 months (SD, 71.5 months); 163 (58.5%) were men, and 209 (71.8%) were white. Three hundred sixty patients (78.1%) had a shunt series performed during their ED evaluation, and 410 (88.9%) had a CT scan of the head. Seventy-one patients (15.4%) were diagnosed with shunt malfunction. Twenty-two had a normal cranial CT scan. Of these patients, 6 had an abnormal shunt series, and 14 had a normal shunt series.Conclusions: The routine use of the shunt series seems warranted in the evaluation of the child with suspected shunt malfunction as children with shunt malfunction may present with a normal cranial CT scan but an abnormal shunt series.