Cohen Joanna S, Jamal Nazreen, Dawes Candice, Chamberlain James M, Atabaki Shireen M
Division of Emergency Medicine, Children's National Medical Center, The George Washington University School of Medicine, Washington, DC.
Department of Pediatrics, Children's National Medical Center, The George Washington University School of Medicine, Washington, DC.
J Emerg Med. 2014 Apr;46(4):449-55. doi: 10.1016/j.jemermed.2013.08.137. Epub 2014 Jan 25.
Computed tomography (CT) scan, the largest medical source of ionizing radiation in the United States, is used to test for failure of ventricular peritoneal shunts.
To quantify the exposure to cranial CT scans in pediatric patients presenting with symptoms of shunt malfunction, and to measure the association of signs and symptoms with clinical shunt malfunction and the need for neurosurgical intervention within 30 days of presentation.
This was a quality improvement study evaluating a pathway used by providers in a tertiary care pediatric emergency department with 85,000 patient visits per year, by retrospective chart review of 223 patient visits for suspected shunt malfunction. We determined the median CT scan per patient per year and the association of signs and symptoms on the pathway with radiological signs of shunt failure and neurosurgical intervention within 30 days of scan.
The median exposure was 2.6 (interquartile range 1.44-4.63) scans per patient per year. Among 11 signs and symptoms, none was associated with radiologic shunt failure. Neurosurgical intervention within 30 days was positively associated with bulging fontanelle (adjusted odds ratio [AOR] 11.78; 95% confidence interval [CI] 1.67-83.0) and behavioral change (AOR 3.01; 95% CI 1.14-7.93), and negatively associated with seizure (AOR 0.13; 95% CI 0.02-0.79) and fever (AOR 0.15; 95% CI 0.04-0.55).
Patients with ventricular peritoneal shunts underwent many cranial CT scans each year. None of the signs or symptoms included on the clinical pathway was predictive of changes on CT scan.
计算机断层扫描（CT）是美国最大的电离辐射医学来源，用于检测脑室腹腔分流术的失败情况。
量化出现分流功能障碍症状的儿科患者接受头颅CT扫描的辐射暴露量，并测量症状体征与临床分流功能障碍以及就诊后30天内神经外科干预需求之间的关联。
这是一项质量改进研究，通过对一家每年有85000例患者就诊的三级儿科急诊科的医疗服务提供者所采用的流程进行评估，对223例疑似分流功能障碍患者的就诊记录进行回顾性分析。我们确定了每位患者每年CT扫描的中位数，并分析了该流程中的症状体征与分流失败的放射学表现以及扫描后30天内神经外科干预之间的关联。
每位患者每年CT扫描的中位数为2.6次（四分位间距为1.44 - 4.63次）。在11种症状体征中，没有一种与放射学分流失败相关。就诊后30天内进行神经外科干预与囟门膨出呈正相关（调整后的优势比[AOR]为11.78；95%置信区间[CI]为1.67 - 83.0）和行为改变（AOR为3.01；95% CI为1.14 - 7.93），与癫痫发作（AOR为0.13；95% CI为0.02 - 0.79）和发热（AOR为0.15；95% CI为0.04 - 0.55）呈负相关。
脑室腹腔分流术患者每年接受多次头颅CT扫描。临床流程中包含的任何症状体征均不能预测CT扫描结果的变化。
