Diagnostic modalities to determine ventriculoperitoneal shunt malfunction : A systematic review and meta-analysis
Published by Elsevier Inc..
BACKGROUND: Ventriculoperitoneal (VP) shunt malfunction is an emergency. Timely diagnosis can be challenging because shunt malfunction often presents with symptoms mimicking other common pediatric conditions.
METHODS: We performed a systematic review and meta-analysis to determine which commonly used imaging modalities; Magnetic resonance imaging (MRI), Computed Tomography (CT), X-ray Shunt series or Optic Nerve Sheath Diameter (ONSD) ultrasound, are superior in evaluating shunt malfunction.
INCLUSION CRITERIA: patients less than 21 years old with symptoms of shunt malfunction. We calculated the pooled sensitivity, specificity, Likelihood Ratios (LR+, LR-) using a random-effects model.
RESULTS: Eight studies were included encompassing 1906 patients with a prevalence of VP shunt malfunction of (29.3%). Shunt series: sensitivity (14%-53%), specificity (99%), LR+ (23.2), and LR- (0.47-0.87). CT scan: sensitivity (53%-100%), specificity (27%-98%), LR+ (1.34-22.87), LR- (0.37). MRI: sensitivity (57%), specificity (93%), LR+ (7.66), and LR- (0.49). ONSD: sensitivity (64%), specificity (22%-68%), LR+ (4.4-8.7), LR- (0.93). A positive shunt series, CT scan, MRI, or ONSD has a post-test probability of (23%-84%). A normal shunt series, CT scan, MRI, or ONSD results in a post-test probability of (7%-31%). A positive shunt series results in a post-test probability of 80%, which is equivalent to the post-test probability of CT scan (23-84%) and MRI (83%).
CONCLUSION: Despite the low sensitivity, a positive shunt series obviates the need for further imaging studies. Prompt referral for neurosurgical intervention is recommended. A negative shunt series or any result (positive or negative) from CT, MRI, or ONSD will still require an emergent neurosurgical referral.
Errataetall: |
CommentIn: Am J Emerg Med. 2022 Aug;58:329-330. - PMID 35400540 |
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Medienart: |
E-Artikel |
Erscheinungsjahr: |
2021 |
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Erschienen: |
2021 |
Enthalten in: |
Zur Gesamtaufnahme - volume:39 |
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Enthalten in: |
The American journal of emergency medicine - 39(2021) vom: 16. Jan., Seite 180-189 |
Sprache: |
Englisch |
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Beteiligte Personen: |
Jayanth, Aditi [VerfasserIn] |
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Links: |
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Themen: |
Computed tomography |
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Anmerkungen: |
Date Completed 08.02.2021 Date Revised 19.07.2022 published: Print-Electronic CommentIn: Am J Emerg Med. 2022 Aug;58:329-330. - PMID 35400540 Citation Status MEDLINE |
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doi: |
10.1016/j.ajem.2020.09.024 |
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funding: |
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Förderinstitution / Projekttitel: |
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PPN (Katalog-ID): |
NLM316365203 |
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500 | |a published: Print-Electronic | ||
500 | |a CommentIn: Am J Emerg Med. 2022 Aug;58:329-330. - PMID 35400540 | ||
500 | |a Citation Status MEDLINE | ||
520 | |a Published by Elsevier Inc. | ||
520 | |a BACKGROUND: Ventriculoperitoneal (VP) shunt malfunction is an emergency. Timely diagnosis can be challenging because shunt malfunction often presents with symptoms mimicking other common pediatric conditions | ||
520 | |a METHODS: We performed a systematic review and meta-analysis to determine which commonly used imaging modalities; Magnetic resonance imaging (MRI), Computed Tomography (CT), X-ray Shunt series or Optic Nerve Sheath Diameter (ONSD) ultrasound, are superior in evaluating shunt malfunction | ||
520 | |a INCLUSION CRITERIA: patients less than 21 years old with symptoms of shunt malfunction. We calculated the pooled sensitivity, specificity, Likelihood Ratios (LR+, LR-) using a random-effects model | ||
520 | |a RESULTS: Eight studies were included encompassing 1906 patients with a prevalence of VP shunt malfunction of (29.3%). Shunt series: sensitivity (14%-53%), specificity (99%), LR+ (23.2), and LR- (0.47-0.87). CT scan: sensitivity (53%-100%), specificity (27%-98%), LR+ (1.34-22.87), LR- (0.37). MRI: sensitivity (57%), specificity (93%), LR+ (7.66), and LR- (0.49). ONSD: sensitivity (64%), specificity (22%-68%), LR+ (4.4-8.7), LR- (0.93). A positive shunt series, CT scan, MRI, or ONSD has a post-test probability of (23%-84%). A normal shunt series, CT scan, MRI, or ONSD results in a post-test probability of (7%-31%). A positive shunt series results in a post-test probability of 80%, which is equivalent to the post-test probability of CT scan (23-84%) and MRI (83%) | ||
520 | |a CONCLUSION: Despite the low sensitivity, a positive shunt series obviates the need for further imaging studies. Prompt referral for neurosurgical intervention is recommended. A negative shunt series or any result (positive or negative) from CT, MRI, or ONSD will still require an emergent neurosurgical referral | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a Meta-Analysis | |
650 | 4 | |a Systematic Review | |
650 | 4 | |a Computed tomography | |
650 | 4 | |a Likelihood ratios | |
650 | 4 | |a MRI | |
650 | 4 | |a Sensitivity | |
650 | 4 | |a Shunt series | |
650 | 4 | |a Specificity | |
650 | 4 | |a Ventriculoperitoneal shunt | |
700 | 1 | |a Benabbas, Roshanak |e verfasserin |4 aut | |
700 | 1 | |a Chao, Jennifer |e verfasserin |4 aut | |
700 | 1 | |a Sinert, Richard |e verfasserin |4 aut | |
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