Header

UZH-Logo

Maintenance Infos

Shunt age-related complications in adult patients with suspected shunt dysfunction. A recommended diagnostic workup


Spirig, José M; Frank, Melanie N; Regli, Luca; Stieglitz, Lennart Henning (2017). Shunt age-related complications in adult patients with suspected shunt dysfunction. A recommended diagnostic workup. Acta Neurochirurgica, 159(8):1421-1428.

Abstract

BACKGROUND: Patients admitted for suspicion of shunt dysfunction (SD) often show unspecific symptoms and require time-consuming, expensive and even invasive diagnostics involving significant radiation exposure. The purpose of this retrospective study was to analyse the current diagnostic procedures and to propose a process optimisation.
METHOD: As all patients admitted for suspicion of SD receive imaging studies, we searched for adult patients receiving neuroimaging in the period from January 2010 to July 2013, analysing referring diagnosis, clinical signs, products, diagnostic process and final diagnosis. Recursive partitioning was used to define time intervals for differentiating types of SD.
RESULTS: A total of 148 patients, aged 18-89 (mean, 54) years, were studied. Forty-two percent were referred by a hospital or rehabilitation centre, 30% by general practitioners and 24% were self-referrals. The admission diagnosis was in the majority "shunt dysfunction" only. Further differentiations were rarely made. An SD was confirmed in 46% of the patients. In 17%, the symptoms were based on another cause and in 37% they could not be clearly attributed to any specific disorder. Abdominal dislocations (2%) and shunt infections (5%) were found within the first 6 months. Over- (3%) and under-drainage (14%) were the most frequent complications during the first 4 years. Disconnections (13%) occurred generally 4 years or more after implantation. Only shunt obstruction (9%) showed no temporal pattern.
CONCLUSIONS: Symptoms of SD remain mostly unspecific. This study showed that the type of SD depends on the time interval from implantation. We propose a workup strategy for patients with SD based on the temporal profile.

Abstract

BACKGROUND: Patients admitted for suspicion of shunt dysfunction (SD) often show unspecific symptoms and require time-consuming, expensive and even invasive diagnostics involving significant radiation exposure. The purpose of this retrospective study was to analyse the current diagnostic procedures and to propose a process optimisation.
METHOD: As all patients admitted for suspicion of SD receive imaging studies, we searched for adult patients receiving neuroimaging in the period from January 2010 to July 2013, analysing referring diagnosis, clinical signs, products, diagnostic process and final diagnosis. Recursive partitioning was used to define time intervals for differentiating types of SD.
RESULTS: A total of 148 patients, aged 18-89 (mean, 54) years, were studied. Forty-two percent were referred by a hospital or rehabilitation centre, 30% by general practitioners and 24% were self-referrals. The admission diagnosis was in the majority "shunt dysfunction" only. Further differentiations were rarely made. An SD was confirmed in 46% of the patients. In 17%, the symptoms were based on another cause and in 37% they could not be clearly attributed to any specific disorder. Abdominal dislocations (2%) and shunt infections (5%) were found within the first 6 months. Over- (3%) and under-drainage (14%) were the most frequent complications during the first 4 years. Disconnections (13%) occurred generally 4 years or more after implantation. Only shunt obstruction (9%) showed no temporal pattern.
CONCLUSIONS: Symptoms of SD remain mostly unspecific. This study showed that the type of SD depends on the time interval from implantation. We propose a workup strategy for patients with SD based on the temporal profile.

Statistics

Citations

Dimensions.ai Metrics
1 citation in Web of Science®
1 citation in Scopus®
1 citation in Microsoft Academic
Google Scholar™

Altmetrics

Downloads

4 downloads since deposited on 22 Feb 2018
4 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:shunt dysfunction, shunt complication, shunt malfunction, shunt failure, ventriculoperitoneal shunt, cerebrospinal fluid shunt
Language:English
Date:August 2017
Deposited On:22 Feb 2018 17:25
Last Modified:14 Jun 2018 00:00
Publisher:Springer
ISSN:0001-6268
Additional Information:The final publication is available at Springer via https://doi.org/10.1007/s00701-017-3237-6
OA Status:Green
Publisher DOI:https://doi.org/10.1007/s00701-017-3237-6
PubMed ID:28616668

Download

Download PDF  'Shunt age-related complications in adult patients with suspected shunt dysfunction. A recommended diagnostic workup'.
Preview
Content: Accepted Version
Filetype: PDF
Size: 1MB
View at publisher