United States emergency department visits for children with cerebrospinal fluid shunts

Abstract

OBJECTIVECSF 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).METHODSA 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.RESULTSIn 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).CONCLUSIONSBetween 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.

Symptoms of Cerebrospinal Shunt Malfunction in Young Children: A National Caregiver Survey

“…20,21 Recent data demonstrates that despite a nearly 20% increase in emergency department visits between 2006-2017 among children with shunts, overall fewer children received surgical interventions because of access to MRIs. 22 Caregivers can be encouraged to bring their children to attention with concerning symptoms, as evaluation will result in neither excess radiation exposure nor unnecessary interventions. Additionally, rapid MRI is increasingly available 23 though associated with a longer time to imaging (53 min) and a longer emergency department length of stay (52 min).…”

The Impact of Social Determinants of Health in Pediatric Shunted Hydrocephalus

“…The data span January 1, 2010, through October 31, 2020. International Classification of Diseases 9 and 10 (ICD-9 and ICD-10) diagnosis and procedure codes and Current Procedural Terminology codes were used in the identification of children who underwent surgery for CSF diversion, the indications for procedures, and social risk factors as previously defined (Supplemental Table 1, http://links.lww.com/NEU/ D575). [17][18][19] Patients were identified as having social risk factors if they had a family member with alcohol and/or drug problem (alcoholism in family and substance abuse in the family), a history of abuse (child abuse and history of physical, emotional, or other psychological abuse), separated parents (divorce or estrangement), been in foster care or welfare custody, difficult educational circumstances or illiteracy, housing instability (lack of housing or inadequate housing), and been raised in an environment of economic strain (inadequate material resources, other housing or economic circumstances, or legal circumstances) within their available record. The coding procedure is summarized in Supplemental Table 1, http://links.lww.com/NEU/D575.…”

Treatment Strategies and Challenges to Avoid Cerebrospinal Fluid Shunting for Pediatric Hydrocephalus

“…2) Importantly, in routine clinical practice, diagnosing shunt dysfunction in pediatric cases is challenging. 12,13) Nonspecific symptoms are often caused by shunt dysfunction. The possibility of shunt dysfunction should always be kept in mind when assessing pediatric patients with a VP shunt placement.…”