title: Test characteristics of parent's visual analog scale score in predicting ventriculoperitoneal shunt malfunction in the pediatric emergency department.
abstract: OBJECTIVE
  Many parents of children with ventriculoperitoneal shunts present to the emergency department for evaluation of a possible shunt malfunction. No study to date has evaluated their ability to predict a shunt malfunction. Our study objective was to evaluate parents' accuracy for predicting a shunt malfunction in their child. We hypothesize that parents more experienced with prior shunt malfunctions are better able to predict subsequent malfunctions in their child.
  
  
  METHODS
  We conducted a prospective, descriptive study on children younger than 18 years presenting to our tertiary care pediatric emergency department with a possible ventriculoperitoneal shunt malfunction. Parents rated the likelihood of a shunt malfunction using an unmarked 100-mm visual analog scale marked definitely malfunctioning at the high end. An experienced parent was defined as one who had previously experienced at least 3 shunt malfunctions in their child.
  
  
  RESULTS
  We enrolled 85 parent-child dyads in our study. Twenty-four children were diagnosed with a malfunction. The predictive ability of parents to determine a shunt malfunction was found at a threshold visual analog scale score of 66 (sensitivity, 88.9%, and specificity, 62.2%). At a determined threshold value of 85 or more, experienced parents had a high specificity of 89.2% with a positive likelihood ratio of 5.1. Experienced parents showed an area under the curve of 0.7928 (95% confidence interval, 0.6037-0.9819); and inexperienced parents, 0.5611 (95% confidence interval, 0.3646-0.7576) (P = 0.096).
  
  
  CONCLUSIONS
  Experienced parents are better able to predict a shunt malfunction in their child.
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA 92354, USA. tommyyhokim@yahoo.com
authors.forename: Tommy Y
authors.initials: TY
authors.lastname: Kim
authors.forename: Lance
authors.initials: L
authors.lastname: Brown
authors.forename: Gail M
authors.initials: GM
authors.lastname: Stewart
mesh_terms: D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D019544:Equipment Failure Analysis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010146:Pain / Q000175:diagnosis* / Q000209:etiology*; D010147:Pain Measurement; D010287:Parent-Child Relations; D010290:Parents; D010372:Pediatrics / Q000379:methods; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*