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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
  1. Angharad Griffiths1,
  2. Ikechukwu Okafor1,
  3. Thomas Beattie2
  1. 1Children’s Health Ireland at Temple Street
  2. 2University of Edinburgh


Aims/Objectives/Background VP 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/Design Conducted 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).


  • Sensitivity 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.

Results/Conclusions59 SSR’s could have been avoided without adverse clinical outcome.

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