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Parental sensitivity and specificity to recognize shunt malfunction in their child: a single-center prospective study
Amparo Saenz1, Santiago Cicutti1, Romina Argañaraz1
11Department of Neurosurgery, "Prof. Dr. Juan P. Garrahan" Pediatric Hospital, Buenos Aires, Argentina; and.
Insights
Parents can identify ventriculoperitoneal shunt (VPS) failure with moderate sensitivity. Knowledge of symptoms and communication with neurosurgeons improve parental diagnostic accuracy for shunt malfunction.
Area of Science:
- Pediatric Neurosurgery
- Medical Diagnostics
- Patient Care
Background:
- Ventriculoperitoneal shunts (VPS) are crucial for managing hydrocephalus in children.
- Recognizing VPS failure promptly is essential to prevent neurological damage.
- Parental awareness plays a role in early detection of shunt complications.
Purpose of the Study:
- To evaluate the diagnostic performance of parents in identifying VPS failure in pediatric patients.
- To determine factors influencing parents' ability to recognize shunt blockage.
Main Methods:
- Prospective cohort study of 91 pediatric patients (0-18 years) with VPS presenting to the ER.
- Parental interviews and patient assessments to confirm VPS malfunction via surgery or follow-up.
- Data collected between 2021 and 2022.
Main Results:
- 59.3% of patients had confirmed VPS blockage.
- Parental sensitivity for detecting VPS failure was 66.7%, with specificity of 21.6%.
- Factors associated with accurate parental recognition included knowing more symptoms (OR 2.4), reporting vomiting/headache (OR 6), and knowing the neurosurgeon's name (OR 3.5).
Conclusions:
- Increased parental knowledge of shunt failure symptoms and better communication with neurosurgeons enhance diagnostic sensitivity.
- Educating parents and fostering strong physician-parent relationships can improve early detection of VPS complications.
- Parental awareness is a valuable component in managing pediatric hydrocephalus.
Objective:
The objective of this study was to estimate the diagnostic performance (sensitivity, specificity, positive predictive value, and negative predictive value) for recognizing ventriculoperitoneal shunt (VPS) failure in the parents of patients 0-18 years of age who attended the hospital's emergency room (ER). The second objective was to identify the factors associated with the parents' ability to recognize the shunt blockage (true positives).
Methods:
A prospective cohort study was conducted between 2021 and 2022 including all patients 0-18 years of age who had a VPS and attended the hospital's ER with symptoms that could correspond to VPS blockage. Parents were interviewed on admission and patients were assessed over time to discover potential VPS malfunction by surgery or follow-up. Consent was obtained from all participants.
Results:
Ninety-one patients were surveyed, and 59.3% showed evidence of a confirmed VPS blockage. Parental sensitivity was 66.7%, with a specificity of 21.6%. An association was found between parents who could correctly identify their child's shunt block and the number of symptoms of shunt failure that the parent could name (OR 2.4, p < 0.05) as well as parents who reported vomiting and headache as symptoms of shunt malfunction (OR 6, p < 0.05). Parents who knew the first and last name of their primary neurosurgeon (OR 3.5, p < 0.05) also had better diagnostic sensitivity.
Conclusions:
Parents who are more knowledgeable of their child's disease, as well as parents who have good communication with their neurosurgeon, were found to have better diagnostic sensitivity.
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