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J Pediatr. 2017 Mar;182:210-216.e1. doi: 10.1016/j.jpeds.2016.11.051. Epub 2016 Dec 15.

The Burden of Ionizing Radiation Studies in Children with Ventricular Shunts.

Author information

1
Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: Maria.antonucci@upmc.edu.
2
Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
3
Department of Neurological Surgery, Division of Pediatric Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
4
Department of Radiology, Division of Pediatric Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
5
Department of Pediatrics, Division of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
6
Department of Pediatrics, Division of Pediatric Emergency Medicine and Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Abstract

OBJECTIVES:

To quantify the number of shunt-related imaging studies that patients with ventricular shunts undergo and to calculate the proportion of computed tomography (CT) scans associated with a surgical intervention.

STUDY DESIGN:

Retrospective longitudinal cohort analysis of patients up to age 22 years with a shunt placed January 2002 through December 2003 at a pediatric hospital. Primary outcome was the number of head CT scans, shunt series radiograph, skull radiographs, nuclear medicine, and brain magnetic resonance imaging studies for 10 years following shunt placement. Secondary outcome was surgical interventions performed within 7 days of a head CT. Descriptive statistics were used for analysis.

RESULTS:

Patients (n = 130) followed over 10 years comprised the study cohort. The most common reasons for shunt placement were congenital hydrocephalus (30%), obstructive hydrocephalus (19%), and atraumatic hemorrhage (18%), and 97% of shunts were ventriculoperitoneal. Patients underwent a median of 8.5 head CTs, 3.0 shunt series radiographs, 1.0 skull radiographs, 0 nuclear medicine studies, and 1.0 brain magnetic resonance imaging scans over the 10 years following shunt placement. The frequency of head CT scans was greatest in the first year after shunt placement (median 2.0 CTs). Of 1411 head CTs in the cohort, 237 resulted in surgical intervention within 7 days (17%, 95% CI 15%-19%).

CONCLUSIONS:

Children with ventricular shunts have been exposed to large numbers of imaging studies that deliver radiation and most do not result in a surgical procedure. This suggests a need to improve the process of evaluating for ventricular shunt malfunction and minimize radiation exposure.

KEYWORDS:

emergency medicine; pediatrics; radiation; ventricular shunts

PMID:
27989409
DOI:
10.1016/j.jpeds.2016.11.051
[Indexed for MEDLINE]

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