Utility of a diagnostic scale for ventriculoperitoneal shunt dysfunction in a pediatric emergency service

Abstract

Introduction: Ventriculoperitoneal shunts (VPS) are associated with a risk of valvular dysfunction (VD) in up to 40%, so it is important to use clinical scales in order to reduce the request for unnecessary auxiliary methods.

Objective: To evaluate the usefulness of the diagnostic scale designed by Muñoz-Santanach in children with clinical suspicion of VD

Materials and methods: Observational, analytical, diagnostic method, temporally retrospective study, which evaluated children aged 1 month to 15 years with VPS who attended the pediatric emergency department for suspected VD between 2013 and 2023. The scale has 9 variables, high risk of VD scores

≥ 7. Gold standard considered: valve replacement surgery. Frequencies, median, and IQR were described. The scale was evaluated with statistics for diagnostic tests.

Results: A total of 59 patients with a total of 72 events of suspected VD were included, and this diagnosis was confirmed in 19/72. The median age was 1 year (IQR: 6 m to 2.3 y), 45/72 male. The most frequent reasons for consultation were vomiting in 45/72, behavioural alteration in 25/72 and seizures in 14/72.

On 46/72 we performed a head CT, 52/72 abdominal ultrasound and 57/72 X-ray of the path.  Of the 19 events with confirmed VD, 12/19 had a score ≥7, among the 53 without DV a total score ≤ 6 obtained a total of 45/53, with these values a sensitivity of 63%, specificity 85%, PVV 60%, NPV 87%. LR+ 4.2 and LR- 0.4. The area under the curve of the values obtained was 0.801 (95% CI: 0.67-0.92. with p <0.01)

Conclusion: The utility of the proposed scale is moderate, with values <7 there is a high probability that it is not a VD, however, with values ≥ 7 it should be complemented with imaging studies to confirm or rule out a VD and eliminate the possibilities of false negatives.