Ouellette David, Lynch Timothy, Bruder Eric, Everson Edward, Joubert Gary, Seabrook Jamie A, Lim Rodrick K
Division of Emergency Medicine, Department of Medicine, University of Western Ontario, London, Ontario, Canada.
Pediatr Emerg Care. 2009 Dec;25(12):827-30. doi: 10.1097/PEC.0b013e3181c07461.
To measure the predictive value of nuclear medicine studies (cerebrospinal fluid [CSF] shuntograms) and radiographic studies (computed tomographic [CT] scans) in a cohort of children undergoing evaluation for suspected shunt obstruction in a tertiary care pediatric emergency department (ED).
A retrospective chart review was conducted on patients younger than 18 years who presented to the pediatric ED of the Children's Hospital of Western Ontario and had both CT of the head and a CSF shuntogram ordered by the attending pediatric emergency medicine physician between December 1998 and April 2003 because of suspected shunt obstruction.
A total of 69 patients were evaluated for suspected shunt obstruction in the ED during this period with both a CT and a CSF shuntogram. Twenty-seven patients (39.1%) subsequently required corrective surgery for suspected shunt obstruction that was confirmed intraoperatively. The CT scans showed abnormalities suggestive of CSF shunt obstruction in 21 of the patients who required surgery (sensitivity, 77.8%; negative predictive value, 82.4%), whereas the CSF shuntograms showed abnormalities suggestive of CSF obstruction in 25 of the patients who required surgery (sensitivity, 92.6%; negative predictive value, 92.6%). The CT scans and the shuntograms combined revealed abnormalities suggestive of CSF shunt obstruction in 26 of the 27 patients who required surgery (sensitivity, 96.3%; negative predictive value, 97.4%).
Over one third of pediatric ED patients evaluated with CT and CSF shuntograms required surgical management. Sensitivity was increased with CT and CSF shuntogram compared with CT alone. Prospective studies are required to assess the use of radiographic and nuclear medicine tests for the shunt evaluation in conjunction with the development of a clinical prediction rule for the pediatric emergency physician.
在一家三级医疗儿科急诊科，对一组因疑似分流梗阻而接受评估的儿童，测量核医学检查（脑脊液分流造影）和影像学检查（计算机断层扫描[CT]）的预测价值。
对1998年12月至2003年4月间因疑似分流梗阻而到西安大略儿童医院儿科急诊科就诊、年龄小于18岁且由儿科急诊医学主治医师同时开具头部CT和脑脊液分流造影检查单的患者进行回顾性病历审查。
在此期间，共有69例因疑似分流梗阻在急诊科接受了CT和脑脊液分流造影检查。27例患者（39.1%）随后因术中证实的疑似分流梗阻而需要进行矫正手术。在需要手术的患者中，21例CT扫描显示有提示脑脊液分流梗阻的异常（敏感性为77.8%；阴性预测值为82.4%），而25例需要手术的患者脑脊液分流造影显示有提示脑脊液梗阻的异常（敏感性为92.6%；阴性预测值为92.6%）。CT扫描和分流造影联合检查显示，在27例需要手术的患者中有26例有提示脑脊液分流梗阻的异常（敏感性为96.3%；阴性预测值为97.4%）。
超过三分之一接受CT和脑脊液分流造影检查的儿科急诊科患者需要手术治疗。与单独使用CT相比，CT和脑脊液分流造影联合使用时敏感性有所提高。需要进行前瞻性研究，以评估影像学和核医学检查在分流评估中的应用，并为儿科急诊医师制定临床预测规则。
