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

2020 ◽  
pp. archdischild-2020-320294
Author(s):  
George Beattie ◽  
Saurabh Sinha ◽  
Suzanne Mason ◽  
Daniel JA Connolly ◽  
Michael Paddock
Keyword(s):  
Shunt Failure ◽  
Head Ct ◽  
Shunt Series

Parental recognition of shunt failure: a prospective single-institution study

2012 ◽  
Vol 9 (4) ◽  
pp. 363-371 ◽  
Author(s):  
Robert P. Naftel ◽  
Emily Tubergen ◽  
Chevis N. Shannon ◽  
Kimberly A. Gran ◽  
E. Haley Vance ◽  
...  
Keyword(s):  
Diagnostic Test ◽  
Shunt Failure ◽  
Predictive Values ◽  
Head Ct ◽  
Test Characteristics ◽  
Parental Response ◽  
Parental Recognition ◽  
Sensitivity Specificity ◽  
Post Hoc ◽  
Shunt Series

Object Because there is no gold standard for preoperative diagnosis of shunt failure, understanding the sensitivity, specificity, and predictive values of symptoms, signs, and diagnostic tests enables practitioners to make logical clinical decisions. Parents of children with shunts undergo educational instruction to enable them to recognize shunt failure. The authors prospectively investigated parental ability to recognize shunt failure. Methods Data were prospectively collected on 205 consecutive encounters in 153 children with shunted hydrocephalus presenting to the emergency department or clinic, or as an inpatient consultation, to the Children's Hospital of Alabama between April and October 2010. Regardless of the complaint, all parents were asked if they believed the shunt was in failure. Six children were excluded from analysis because a parental response was lacking. Using the Shunt Design Trial definitions, shunt failure was diagnosed intraoperatively or ruled out if the child did not undergo shunt revision within 1 week of presentation. Sensitivity, specificity, predictive values, and accuracy were calculated using the parental response and shunt failure diagnosis. Secondarily, parents were compared based on their experience with shunt failure in their children; experienced parents were defined as having experienced at least 3 shunt failures. Post hoc analysis evaluated diagnostic test characteristics among hydrocephalus causes and compared parental recognition of shunt failure to head CT and shunt series diagnostic test characteristics. Parents also completed a standardized shunt failure survey regarding their shunt teaching education and symptom tracking. Results Children enrolled were a mean age of 6.9 years old, 92 (46%) of the encounters were with male patients, and most patients were Caucasian (69%) and had undergone an average of 2.8 previous shunt revisions. Seventy-one children (36%) were diagnosed with shunt failure. Parental response diagnostic test characteristics were: positive predictive value (PPV) of 41%, negative predictive value (NPV) of 79%, sensitivity of 83%, specificity of 34%, and accuracy of 52% for shunt failure. Sixty-three parents were considered experienced and responded with a PPV of 29%, NPV of 92%, sensitivity of 94%, specificity of 23%, and accuracy of 41%. One hundred thirty-six parents were considered inexperienced and responded with a PPV of 48%, NPV of 75%, sensitivity of 80%, specificity of 41%, and accuracy of 57%. When statistically compared, experienced parents had significantly lower PPV (29% vs 48%, respectively; p = 0.035) and accuracy (41% vs 57%, respectively; p = 0.049) than inexperienced parents. On post hoc analysis, parental recognition of shunt failure was inferior to head CT and shunt series diagnostic tests with a lower specificity (20% vs 88%, respectively; p < 0.0005), PPV (44% vs 84%, respectively; p < 0.0005), NPV (61% vs 85%, respectively; p = 0.006), and accuracy (47% vs. 85%, respectively; p < 0.0005). Conclusions The overall parental response had the greatest value in ruling out shunt failure, reflected in the high NPV, particularly in experienced parents. The head CT and shunt series provide more favorable diagnostic test characteristics than the parental response. Although educational interventions have decreased shunt-related deaths, parents have difficulty differentiating shunt failure from alternative diagnoses.

scholarly journals BHCNet: Neural Network based Brain Hemorrhage Classification Using Head CT Scan

IEEE Access ◽  
2021 ◽  
pp. 1-1
Author(s):  
Muhammad Faheem Mushtaq ◽  
Mobeen Shahroz ◽  
Ali M. Aseere ◽  
Habib Shah ◽  
Rizwan Majeed ◽  
...  
Keyword(s):  
Neural Network ◽  
Ct Scan ◽  
Brain Hemorrhage ◽  
Head Ct

Evaluation of age-based radiation dose in paediatric patients received from head CT examination at a tertiary hospital, Nigeria

2021 ◽  
Vol 182 ◽  
pp. 109380
Author(s):  
Muhammad Kabir Abdulkadir ◽  
Iliyasu Yusuf Izge ◽  
Garba Haruna Yunusa ◽  
Abacha Mohammed ◽  
Noor Diyana Osman
Keyword(s):  
Radiation Dose ◽  
Tertiary Hospital ◽  
Head Ct ◽  
Ct Examination ◽  
Paediatric Patients

scholarly journals 332 The diagnostic role of shunt series radiographs (SSR) in children presenting to the children’s emergency department (CED) with suspected ventriculoperitoneal (VP) shunt failure

2020 ◽  
Vol 37 (12) ◽  
pp. 852.3-853
Author(s):  
Angharad Griffiths ◽  
Ikechukwu Okafor ◽  
Thomas Beattie
Keyword(s):  
Clinical Outcome ◽  
Sensitivity And Specificity ◽  
Clinical Information ◽  
Flow Diagram ◽  
List Type ◽  
Shunt Failure ◽  
Vp Shunt ◽  
Wide Range ◽  
Diagnostic Role

Aims/Objectives/BackgroundVP shunts are used to drain CSF from the cranial vault because of a wide range of pathologies and, like any piece of hardware, can fail. Traditionally investigations include SSR and CT. This project examines the role of SSR in evaluating children with suspected VP shunt failure.Primary outcome: Sensitivity and specificity of SSR in children presenting to the CED with concern for shunt failure.Methods/DesignConducted in a single centre, tertiary CED of the national Irish Neurosurgical(NS) referral centre (ED attendance:>50,000 patients/year). 100 sequential SSR requested by the CED were reviewed. Clinical information was extracted from electronic requests. Shunt failure was defined by the need for NS intervention(Revision).Abstract 332 Figure 1Abstract 332 Figure 2Results/ConclusionsSensitivity and specificity is presented in figure 1 (two by two table).100 radiographs performed in 84 children.22% shunts revised (see flow diagram).7 SSR’s were abnormal.85% (n=6) shunts revised. [5 following abnormal CT].Of the normal SSR’s; 16 had abnormal CT and revised.85/100 received CT.64 of 85 CT’s (75%) were normal.□6 of the 64 had focal shunt concern.SSR’s shouldn’t be used in isolation. NPV&PPV, Sensitivity&Specificity is low.SSR’s are beneficial where there’s concern over focal shunt problems (injury/pain/swelling) or following abnormal CT.VP shunt failure is not well investigated with SSR alone.SSR’s could be omitted where there is no focal shunt concern/after normal CT (without impacting clinical outcome) reducing radiation exposure and reduce impact on CED’s.59 SSR’s could have been avoided without adverse clinical outcome.

scholarly journals Cerebrospinal fluid biomarkers of neuroinflammation in children with hydrocephalus and shunt malfunction

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Carolyn A. Harris ◽  
Diego M. Morales ◽  
Rooshan Arshad ◽  
James P. McAllister ◽  
David D. Limbrick
Keyword(s):  
Cerebrospinal Fluid ◽  
Inflammatory Cytokines ◽  
Protein Concentration ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Shunt Failure ◽  
Revision Operation ◽  
Protein Levels ◽  
Anti Inflammatory ◽  
Pro Inflammatory Cytokines

Abstract Background Approximately 30% of cerebrospinal fluid (CSF) shunt systems for hydrocephalus fail within the first year and 98% of all patients will have shunt failure in their lifetime. Obstruction remains the most common reason for shunt failure. Previous evidence suggests elevated pro-inflammatory cytokines in CSF are associated with worsening clinical outcomes in neuroinflammatory diseases. The aim of this study was to determine whether cytokines and matrix metalloproteinases (MMPs) contribute towards shunt failure in hydrocephalus. Methods Using multiplex ELISA, this study examined shunt failure through the CSF protein concentration profiles of select pro-inflammatory and anti-inflammatory cytokines, as well as select MMPs. Interdependencies such as the past number of previous revisions, length of time implanted, patient age, and obstruction or non-obstruction revision were examined. The pro-inflammatory cytokines were IL-1β, IL-2, IL-5, IL-6, IL-8, IL-12, IL-17, TNF-α, GM-CSF, IFN-γ. The anti-inflammatory cytokines were IL-4 and IL-10, and the MMPs were MMP-2, MMP-3, MMP-7, MMP-9. Protein concentration is reported as pg/mL for each analyte. Results Patient CSF was obtained at the time of shunt revision operation; all pediatric (< 18), totaling n = 38. IL-10, IL-6, IL-8 and MMP-7 demonstrated significantly increased concentrations in patient CSF for the non-obstructed subgroup. Etiological examination revealed IL-6 was increased in both obstructed and non-obstructed cases for PHH and congenital hydrocephalic patients, while IL-8 was higher only in PHH patients. In terms of number of past revisions, IL-10, IL-6, IL-8, MMP-7 and MMP-9 progressively increased from zero to two past revisions and then remained low for subsequent revisions. This presentation was notably absent in the obstruction subgroup. Shunts implanted for three months or less showed significantly increased concentrations of IL-6, IL-8, and MMP-7 in the obstruction subgroup. Lastly, only patients aged six months or less presented with significantly increased concentration of IL-8 and MMP-7. Conclusion Non-obstructive cases are reported here to accompany significantly higher CSF cytokine and MMP protein levels compared to obstructive cases for IL-10, IL-6, IL-8, MMP-7 and MMP-9. A closer examination of the definition of obstruction and the role neuroinflammation plays in creating shunt obstruction in hydrocephalic patients is suggested.

scholarly journals Enhancing Ant-Based Algorithms for Medical Image Edge Detection by Admissible Perturbations of Demicontractive Mappings

Symmetry ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 885
Author(s):  
Vasile Berinde ◽  
Cristina Ţicală
Keyword(s):  
Edge Detection ◽  
Medical Image ◽  
Test Functions ◽  
Head Ct ◽  
X Ray ◽  
Numerical Tests ◽  
Image Edge Detection ◽  
Evaluation Of Parameters ◽  
Image Edge ◽  
Demicontractive Mappings

The aim of this paper is to show analytically and empirically how ant-based algorithms for medical image edge detection can be enhanced by using an admissible perturbation of demicontractive operators. We thus complement the results reported in a recent paper by the second author and her collaborators, where they used admissible perturbations of demicontractive mappings as test functions. To illustrate this fact, we first consider some typical properties of demicontractive mappings and of their admissible perturbations and then present some appropriate numerical tests to illustrate the improvement brought by the admissible perturbations of demicontractive mappings when they are taken as test functions in ant-based algorithms for medical image edge detection. The edge detection process reported in our study considers both symmetric (Head CT and Brain CT) and asymmetric (Hand X-ray) medical images. The performance of the algorithm was tested visually with various images and empirically with evaluation of parameters.

scholarly journals Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study

2010 ◽  
Vol 113 (6) ◽  
pp. 1273-1278 ◽  
Author(s):  
Caroline Hayhurst ◽  
Tjemme Beems ◽  
Michael D. Jenkinson ◽  
Patricia Byrne ◽  
Simon Clark ◽  
...  
Keyword(s):  
Revision Rate ◽  
Shunt Revision ◽  
Standard Group ◽  
Fisher Exact Test ◽  
Anatomical Landmarks ◽  
Failure Rates ◽  
Shunt Failure ◽  
Catheter Position ◽  
Optimal Position ◽  
Shunt Placement

Object As many as 40% of shunts fail in the first year, mainly due to proximal obstruction. The role of catheter position on failure rates has not been clearly demonstrated. The authors conducted a prospective cohort study of navigated shunt placement compared with standard blind shunt placement at 3 European centers to assess the effect on shunt failure rates. Methods All adult and pediatric patients undergoing de novo ventriculoperitoneal shunt placement were included (patients with slit ventricles were excluded). The first cohort underwent standard shunt placement using anatomical landmarks. All centers subsequently adopted electromagnetic (EM) navigation for routine shunt placements, forming the second cohort. Catheter position was graded on postoperative CT in both groups using a 3-point scale developed for this study: (1) optimal position free-floating in CSF; (2) touching choroid or ventricular wall; or (3) intraparenchymal. Episodes and type of shunt revision were recorded. Early shunt failure was defined as that occurring within 30 days of surgery. Patients with shunts were followed-up for 12 months in the standard group, for a median of 6 months in the EM-navigated group, or until shunt failure. Results A total of 75 patients were included in the study, 41 with standard shunts and 34 with EM-navigated shunts. Seventy-four percent of navigated shunts were Grade 1 compared with 37% of the standard shunts (p = 0.001, chi-square test). There were no Grade 3 placements in the navigated group, but 8 in the standard group, and 75% of these failed. Early shunt failure occurred in 9 patients in the standard group and in 2 in the navigated group, reducing the early revision rate from 22 to 5.9% (p = 0.048, Fisher exact test). Early shunt failures were due to proximal obstruction in 78% of standard shunts (7 of 9) and in 50% of EM-navigated shunts (1 of 2). Conclusions Noninvasive EM image guidance in shunt surgery reduces poor shunt placement, resulting in a significant decrease in the early shunt revision rate.

scholarly journals Pattern of Emergent Head Computed Tomography Findings in a Tertiary Care Hospital during off Working Hours: Retrospective Analysis

2019 ◽  
Vol 10 (02) ◽  
pp. 207-211
Author(s):  
Rajneesh K. Patel ◽  
Amit Kumar Choubey ◽  
Brijesh K. Soni ◽  
Rajeev Sivasankar ◽  
Vikash Chauhan
Keyword(s):  
Computed Tomography ◽  
Health Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Working Hours ◽  
Care Hospital ◽  
Head Ct ◽  
Total Head ◽  
Ct Head ◽  
Head Computed Tomography

ABSTRACT Introduction: Emergency head computed tomography (CT) is rising exponentially during off working hours due to evidence-based medicine, patient’s expectation and desires, easy availability and apprehension of medico-legal cases, thereby raising health-care cost. There is huge gap in demand and supply of radiologist, especially during off working hours. There is need to know the pattern of emergency head findings. Materials and Methods: A retrospective analysis of all emergent noncontrast CT head during off working hours in the Department of Radiodiagnosis of a Tertiary Care Hospital, Mumbai, India, which were performed from June 2017 to May 2018. CT findings of 308 patients were analyzed. Results: About 63.6% of total head CT showed no significant abnormality. The most common abnormality was intracranial hemorrhage which was just 9.1% followed by acute infarct which was 6.2%. Extradural hemorrhage, subdural hemorrhage, and subarachnoid hemorrhage was only 1% each of total head CT findings. No significant abnormality was detected in 74.65%, 70.21%, 89.13%, 31.37%, 100%, and 69.09% in cases of head injury, seizure, giddiness/dizziness/syncope, cerebrovascular accident, transient ischemic attack, and altered sensorium, respectively. Conclusion: Pattern analysis of emergent head CT reveals that most of the emergent CT head shows no significant abnormality. There is a need for stringent guidelines for emergent head CT, training of emergency physician as well as CT technician for common findings to bridge the radiologist demand-supply gap for providing effective health care in peripheral hospitals.

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