title: Predictors of ventricular shunt infection among children presenting to a pediatric emergency department.
abstract: OBJECTIVE
  Among a population of children with a ventricular shunt presenting to a pediatric emergency department (ED), and in whom cerebrospinal fluid (CSF) was obtained, we sought to (1) determine the rate of positive CSF bacterial culture and (2) identify clinical predictors of ventricular shunt infection.
  
  
  METHODS
  We performed a retrospective cohort study of children 3 months to 21 years of age evaluated in a single pediatric tertiary ED from 1995 to 2008. All included children had CSF obtained within 24 hours of presentation to the ED. A shunt infection was defined by growth of bacteria in the CSF of a child who underwent shunt removal within 7 days of presentation.
  
  
  RESULTS
  Nine hundred seventy-nine children met the inclusion criteria; 130 patients (13%) had growth of bacteria in CSF, of which 58 (5.9% of total) had a shunt infection. The median time since last shunt revision or replacement was shorter for patients with a shunt infection compared with children without shunt infection (44 vs 209 days, P = 0.001). After adjustment for patient age, the following factors were associated with shunt infection: shunt revision within the prior 90 days (adjusted odds ratio [aOR], 2.4; 95% CI, 1.3-4.4), presence of fever (aOR, 8.4; 95% CI, 4.3-16.3), and white blood cell count greater than 15,000/μL (aOR, 3.2; 95% CI, 1.5-6.6).
  
  
  CONCLUSIONS
  Among children with a ventricular shunt who had CSF obtained in the ED, the presence of recent shunt revision, fever, and leukocytosis was associated with ventricular shunt infection.
authors.affiliation: Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908, USA. Elisabeth_rogers@bshsi.org
authors.forename: Elisabeth Ashley
authors.initials: EA
authors.lastname: Rogers
authors.forename: Amir
authors.initials: A
authors.lastname: Kimia
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Madsen
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D020878:Device Removal; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D015994:Incidence; D007223:Infant; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult