Return to the emergency department after ventricular shunt evaluation

Area of Science:

• Neurosurgery
• Pediatrics
• Emergency Medicine

Background:

• Patients with cerebrospinal fluid (CSF) shunts represent a complex medical population.
• Frequent emergency department (ED) visits occur due to suspected shunt malfunction.
• Understanding reasons for short-term revisits is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To investigate the reasons for emergency department (ED) revisits within 7 days of an initial visit for patients with shunted hydrocephalus.
• To identify factors contributing to potentially preventable return-to-system events.

Main Methods:

• Retrospective analysis of 1509 eligible emergency department (ED) visits for patients with shunted hydrocephalus between 2010 and 2013.
• Exclusion of visits related to prior procedures, non-shunt issues, or direct admissions/surgeries.
• Categorization of revisit reasons (shunt-related vs. non-shunt-related) and analysis of clinical/socioeconomic factors.

Main Results:

• Of 1176 patients discharged home, 8.6% returned within 7 days; similar rates were observed for patients admitted for observation (6.0%) or to other services (6.5%).
• Over 60% of the 122 revisits were for reasons unrelated to shunt function.
• Younger age, daytime ED arrival, and metropolitan residence were risk factors for revisits.

Conclusions:

• Children with CSF shunts frequently utilize ED services, often for non-shunt-related concerns after an initial shunt evaluation.
• A significant portion of short-term ED revisits are not directly linked to shunt malfunction, challenging the notion of preventability.
• Careful consideration of patient complexity is necessary when assessing return-to-system events in this population.