Clinical scale for the diagnosis of ventriculoperitoneal shunt malfunction in children in Emergency Department

Abstract Introduction It is well known that some symptoms in children with ventriculoperitoneal shunt are associated with a higher risk of developing shunt malfunction. However none of those symptoms are sensitive or specific enough to diagnose the shunt malfunction. Objective To develop a diagnostic scale to identify children with an increased risk of shunt malfunction in the Emergency Department. Material and methods This is a prospective study including children aged one to eighteen years old admitted to the Emergency Department between April 2010 and March 2013 with symptoms of ventriculoperitoneal shunt malfunction. Logistic regression Analysis was used to determine whether or not the variables were considered independent risk factors for shunt malfunction. The results led to the development of a diagnostic scale. Results A scale was developed using 9 variables (erythema, swelling or discharge from the catheter trajectory, drowsiness, stiff neck, headache, afebrile, age >4 years, vomiting, recent neurological deficit, and time since last surgery ≤2 years) with a maximum score of 20 points. It was found that Scale scores ≥7 points were associated with an increased risk of shunt malfunction (OR 34.0, 95% CI 15.4–74.9; sensitivity 88.3%, specificity 81.1%, PPV 53.4%, NPV 96.7%). Discussion A diagnostic scale is designed for assessing the risk of shunt malfunction, selecting those patients with a higher risk. The use of this scale could help the management of these patients, reducing complementary tests, as well as the usual radiation suffered by these children.