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  • Do children with suspected shunt failure also require a radiographic shunt series if head CT is going to be, or has been, performed?

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Do children with suspected shunt failure also require a radiographic shunt series if head CT is going to be, or has been, performed?
  1. George Beattie1,
  2. Saurabh Sinha2,
  3. Suzanne Mason3,4,
  4. Daniel JA Connolly5,
  5. Michael Paddock6,7
  1. 1 Department of Medicine, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
  2. 2 Department of Neurosurgery, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, UK
  3. 3 Emergency Department, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
  4. 4 School of Health and Related Research, The University of Sheffield, Sheffield, South Yorkshire, UK
  5. 5 Department of Neuroradiology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, UK
  6. 6 Medical Imaging Department, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
  7. 7 Academic Unit of Child Health, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, South Yorkshire, UK
  1. Correspondence to Dr Michael Paddock, Medical Imaging Department, Barnsley Hospital NHS Foundation Trust, Barnsley S75 2EP, UK; michael.paddock{at}nhs.net

https://doi.org/10.1136/archdischild-2020-320294

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    Clinical scenario

    You are the speciality trainee working in a district general hospital Emergency Department (ED). A 4-year-old boy is presented to the ED by his parents following a 48-hour history of progressive headache and vomiting with lethargy and irritability. His parents report that he was born prematurely and has had a ventriculoperitoneal (VP) shunt inserted. He has otherwise been well for the past few weeks and there are no signs or symptoms of infection.

    You want to obtain head CT imaging before discussing with the neurosurgical team but note that he has had numerous previous ED attendances with several radiographic and head CT examinations. You do not want to expose the child to unnecessary ionising radiation. Is a radiographic shunt series (SS) necessary if a head CT is going to be performed?

    Structured clinical question

    Do children with suspected shunt failure (patient) also require a radiographic SS (outcome) if a head CT is going to be, or has been, performed (intervention)?

    Search

    PubMed and MEDLINE databases on NHS Evidence were searched for eligible articles published in English from January 1980 to May 2020. The following search terms were used: (child* OR paediatric OR pediatric) AND (((acute AND failure) OR block*) AND ((ventriculoperitoneal OR VP OR V-P OR cerebral) AND shunt) OR hydrocephalus) AND (computed tomography OR CT OR computed assisted tomography OR CAT) AND ((radiograph* OR (x-ray …

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    Footnotes

    • Contributors Guarantor of integrity of the entire study, study concepts and design, literature research: MP. Clinical studies and statistical analysis: not applicable. Experimental studies/data analysis and manuscript preparation: GB and MP. Manuscript editing: GB, SS, SM, DJAC and MP.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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