Is Shunt Evaluation Useful in Children With Intraventricular Shunts With Seizures?
BACKGROUND
Seizures are a common presenting symptom to the emergency department (ED) in children with intraventricular shunts (IVS). The incidence of shunt malfunction and the yield of imaging studies in children with IVS presenting with seizures is unknown.


OBJECTIVES
We assessed the utility and diagnostic yield of evaluation for shunt malfunction in patients with IVS with seizure and identified clinical predictors for shunt malfunction in these children.


METHODS
We performed a retrospective review of children aged zero to 21 years of age with IVS who presented to the ED with seizure between 2011 and 2015. Demographic, clinical, laboratory and radiological data were collected. Shunt malfunction was diagnosed based on whether a shunt revision was performed during the hospitalization.


RESULTS
We evaluated 408 ED visits (median age: six years [IQR: 3, 11], males 61.5%) for IVS with seizures. Few visits were for first seizure (37; 9.1%) or for status epilepticus (46 visits; 11.3%). Computerized tomography head was performed in 318 patients (95.2%), of which 32 scans (10.6%) were suggestive of shunt malfunction. A shunt series was performed in 302 (90.4%) and was suggestive of shunt malfunction in eight (2.6%) patients. Shunt malfunction was diagnosed in 40 of 408 visits (9.8%). Only a history of multiple (≥3) shunt revisions was significantly associated with shunt malfunction. There was no association between number, type, or prior history of seizures and shunt malfunction.


CONCLUSION
Our study demonstrates a low yield of imaging studies for the evaluation of shunt malfunction in children with IVS with seizures, and shunt malfunction is an uncommon cause of seizures in these children.
['Cohen|Anat|A|', 'Agarwal|Rajkumar|R|', 'Farooqi|Ahmad|A|', 'Kannikeswaran|Nirupama|N|']
D002648:Child D002675:Child, Preschool D015331:Cohort Studies D004636:Emergency Service, Hospital D004868:Equipment Failure D005260:Female D006801:Humans D006849:Hydrocephalus D008297:Male D011237:Predictive Value of Tests D012640:Seizures D013997:Time Factors D015898:Tomography Scanners, X-Ray Computed D017287:Ventriculoperitoneal Shunt
Intraventricular shunts Seizures Computerized tomography head/brain Hydrocephalus