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Updated: Nov 12, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
United States emergency department visits for children with cerebrospinal fluid shunts
Amrita Hari-Raj1, Lauren Q Malthaner2, Junxin Shi2
11The Ohio State University College of Medicine, Columbus.
Insights
Pediatric emergency department visits for suspected hydrocephalus shunt malfunction increased 18% from 2006-2017. Despite this rise, surgical interventions decreased, with more children discharged home from the ED.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Health Services Research
Background:
- Cerebrospinal fluid (CSF) shunts are primary treatment for hydrocephalus.
- Shunt malfunctions are common complications, potentially causing neurological deficits.
- Limited data exists on the epidemiology of pediatric shunt malfunctions in US emergency departments (EDs).
Purpose of the Study:
- To characterize the epidemiology of pediatric patients presenting to US emergency departments with possible CSF shunt malfunctions.
- To analyze trends in diagnosis, imaging, and management of these cases between 2006 and 2017.
Main Methods:
- Retrospective study using the 2006-2017 National Emergency Department Sample (NEDS).
- Data queried using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9/ICD-10) codes for hydrocephalus, shunt malfunction, and revision procedures.
- Analysis of patient demographics, imaging use (CT, MRI), and disposition (discharge, surgery).
Main Results:
- An estimated 16,376 ED visits for suspected shunt malfunction occurred in 2017.
- Pediatric ED visits for suspected shunt malfunction increased by 18% between 2006 and 2017.
- Despite increased visits, ED discharges increased by 76.3% and surgical interventions decreased by 32.9%.
Conclusions:
- Pediatric ED visits for shunt malfunction evaluation rose significantly from 2006-2017.
- A trend towards decreased surgical intervention and increased ED discharges was observed.
- Potential factors include improved diagnostic criteria, alternative treatments, and increased advanced imaging use.
Objective:
CSF shunt placement is the primary therapy for hydrocephalus; however, shunt malfunctions remain common and lead to neurological deficits if missed. There is a lack of literature characterizing the epidemiology of children with possible shunt malfunctions presenting to United States emergency departments (EDs).
Methods:
A retrospective study was conducted of the 2006-2017 National Emergency Department Sample. The data were queried using an exhaustive list of Current Procedural Terminology and International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes representing children with hydrocephalus diagnoses, diagnostic imaging for shunt malfunctions, and shunt-related surgical revision procedures.
Results:
In 2017, there were an estimated 16,376 ED visits for suspected shunt malfunction. Children were more commonly male (57.9%), ages 0-4 years (42.2%), and publicly insured (55.8%). Many did not undergo diagnostic imaging (37.2%), and of those who did, most underwent head CT scans (43.7%). Between 2006 and 2017, pediatric ED visits for suspected shunt malfunction increased 18% (95% CI 12.1-23.8). The use of MRI increased substantially (178.0%, 95% CI 176.9-179.2). Visits resulting in discharge home from the ED increased by 76.3% (95% CI 73.1-79.4), and those involving no surgical intervention increased by 32.9% (95% CI 29.2-36.6).
Conclusions:
Between 2006 and 2017, ED visits for children to rule out shunt malfunction increased, yet there was a decline in surgical intervention and an increase in discharges home from the ED. Possible contributing factors include improved clinical criteria for shunt evaluation, alternative CSF diversion techniques, changing indications for shunt placement, and increased use of advanced imaging in the ED.
Abbreviations:
CPT = Current Procedural Terminology; ED = emergency department; ETV = endoscopic third ventriculostomy; ICD-9 = International Classification of Diseases, Ninth Revision; ICD-10 = International Classification of Diseases, Tenth Revision; NEDS = National Emergency Department Sample.
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