title: [Clinical scale for the diagnosis of ventriculoperitoneal shunt malfunction in children in Emergency Department].
abstract: BACKGROUND
  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 enough 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.
  
  
  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%).
  
  
  CONCLUSIONS
  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 the usual radiation suffered by these children.
authors.affiliation: Servicio de Urgencias, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España. Electronic address: dmunoz@hsjdbcn.org.
authors.forename: David
authors.initials: D
authors.lastname: Muñoz-Santanach
authors.affiliation: Servicio de Urgencias, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España.
authors.forename: Victoria
authors.initials: V
authors.lastname: Trenchs Sainz de la Maza
authors.affiliation: Servicio de Neurocirugía, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España.
authors.forename: Santiago
authors.initials: S
authors.lastname: Candela Canto
authors.affiliation: Servicio de Urgencias, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España.
authors.forename: Carles
authors.initials: C
authors.lastname: Luaces Cubells
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D063189:Symptom Assessment; D017211:Treatment Failure; D017287:Ventriculoperitoneal Shunt
keywords: Disfunción valvular; Emergency department; Servicio de urgencias; Shunt malfunction; Ventriculoperitoneal shunt; Válvula ventriculoperitoneal