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Updated: May 3, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Cranial computed tomography utilization for suspected ventriculoperitoneal shunt malfunction in a pediatric emergency
Joanna S Cohen1, Nazreen Jamal1, Candice Dawes2
1Division of Emergency Medicine, Children's National Medical Center, The George Washington University School of Medicine, Washington, DC.
Insights
Pediatric patients with shunts undergo frequent cranial CT scans. Clinical signs and symptoms do not reliably predict shunt failure on CT scans, indicating a need for improved diagnostic methods.
Area of Science:
- Pediatric Neurology
- Medical Imaging
- Neurosurgery
Background:
- Computed tomography (CT) scans are a significant source of ionizing radiation.
- CT scans are frequently used to diagnose ventricular peritoneal shunt malfunction in children.
Purpose of the Study:
- To quantify cranial CT scan exposure in pediatric patients with suspected shunt malfunction.
- To assess the association between clinical signs/symptoms and shunt malfunction requiring intervention.
Main Methods:
- Quality improvement study using retrospective chart review in a pediatric emergency department.
- Analysis of 223 patient visits for suspected shunt malfunction.
- Evaluation of signs and symptoms for prediction of shunt failure and 30-day neurosurgical intervention.
Main Results:
- Median exposure was 2.6 CT scans per patient per year.
- No investigated sign or symptom predicted radiologic shunt failure.
- Bulging fontanelle and behavioral change predicted neurosurgical intervention; seizure and fever were negatively associated.
Conclusions:
- Pediatric patients with shunts receive numerous cranial CT scans annually.
- Clinical signs and symptoms on the pathway were not predictive of CT scan findings for shunt failure.
Background:
Computed tomography (CT) scan, the largest medical source of ionizing radiation in the United States, is used to test for failure of ventricular peritoneal shunts.
Study Objectives:
To quantify the exposure to cranial CT scans in pediatric patients presenting with symptoms of shunt malfunction, and to measure the association of signs and symptoms with clinical shunt malfunction and the need for neurosurgical intervention within 30 days of presentation.
Method:
This was a quality improvement study evaluating a pathway used by providers in a tertiary care pediatric emergency department with 85,000 patient visits per year, by retrospective chart review of 223 patient visits for suspected shunt malfunction. We determined the median CT scan per patient per year and the association of signs and symptoms on the pathway with radiological signs of shunt failure and neurosurgical intervention within 30 days of scan.
Results:
The median exposure was 2.6 (interquartile range 1.44-4.63) scans per patient per year. Among 11 signs and symptoms, none was associated with radiologic shunt failure. Neurosurgical intervention within 30 days was positively associated with bulging fontanelle (adjusted odds ratio [AOR] 11.78; 95% confidence interval [CI] 1.67-83.0) and behavioral change (AOR 3.01; 95% CI 1.14-7.93), and negatively associated with seizure (AOR 0.13; 95% CI 0.02-0.79) and fever (AOR 0.15; 95% CI 0.04-0.55).
Conclusions:
Patients with ventricular peritoneal shunts underwent many cranial CT scans each year. None of the signs or symptoms included on the clinical pathway was predictive of changes on CT scan.
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