Screening for ventricular shunt function in children with hydrocephalus secondary to meningomyelocele.
OBJECTIVE
To evaluate the current method of using computerized tomographic (CT) scans to screen for ventricular shunt failure in children who have hydrocephalus.


METHODS
Retrospective review of 112 randomly selected charts.


METHODS
Children diagnosed with infantile hydrocephalus secondary to meningomyelocele, who were treated at the Andrew J. Kirch Developmental Services Center since 1978.


RESULTS
One hundred and twelve patients were monitored with CT scans for an average of 12.2 years. There was a total of 2,869 CT scans and an average of 2.1 CT scans per year. Shunt failure was diagnosed 76% of the time by symptoms, 15% by physical findings and 8% by routine CT scans. Sixteen patients had no shunt failure, whereas the remaining 96 had 255 shunt failures. Complications occurred during 30 of the 255 admissions. One child died due to complications directly related to shunt failure. No statistically significant correlations were found between the length of stay or complications and method of diagnosis.


CONCLUSIONS
Although children in this study received frequent CT scans, 76% of the episodes of shunt failure were diagnosed because of symptoms. Children admitted to the hospital with symptomatic shunt failure did not have more complications or a longer stay than those diagnosed by routine CT scan. This study suggests that the use of routine CT scans to diagnose shunt failure while patients are asymptomatic does not lead to significantly better medical outcomes and is not cost-effective. However, before routine CT scans are eliminated, a prospective study needs to be conducted that examines outcomes such as cognitive and psychological functioning.
Liptak
G S
GS
Children's Hospital at Strong, University of Rochester Medical Center, Rochester, N.Y. 14642, USA. Gregory_Liptak@urmc.rochester.edu
Bolander
H M
HM
Langworthy
K
K
D002648:Child; D003362:Cost-Benefit Analysis; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging* / Q000209:etiology; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008591:Meningomyelocele / Q000150:complications*; D010808:Physical Examination; D011859:Radiography; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed / Q000191:economics* / Q000592:standards; D017287:Ventriculoperitoneal Shunt