Introduction: Patients with cerebrospinal fluid (CSF) shunts are medically complex and frequently present to the emergency department (ED) with suspected shunt malfunction. After adequate evaluation in the ED, patients may be discharged home, admitted for surgical intervention or admitted for observation. In this study, we examined the reasons for ED revisits within 7 days of the index ED visit.
Methods: 1,509 ED visits were included in this study. Final dispositions from the index ED included: home (n=1,176), admission to neurosurgery service for observation (n=134), and admission to other services (n=199). Subsequent events within 7 days, including ED revisits, hospital admissions and shunt-related surgery were recorded. Reasons for ED revisits were categorized based on whether or not it was related to shunt function concerns. Clinical and socioeconomic factors were analyzed for association with ED revisits.
Results: Of the 1,176 patients discharged home from the ED after shunt function evaluation, 101 returned to ED within 7 days (8.6%). Of the 134 patients admitted by the neurosurgery service for observation only, 8 returned to ED within 7 days of discharge (6.0%). Of the 199 patients admitted to other hospital services besides Neurosurgery, 13 returned to ED within 7 days of discharge (7.5%). The reasons for ED revisits vary (a total of 122 visits combining the 3 groups), but at least 60% of the revisits were clearly not related to shunt function. Younger age, time of arrival during the day, and living within the metropolitan area correlated with increased ED revisits.
Conclusions: Children with CSF shunts are medically complex and utilize ED services often. After an index ED visit where the shunt function was deemed to be the chief concern, the subsequent ED revisit within 7-day is often for complaints unrelated to shunt function.
Patient Care: Patients with CSF shunts utilize ED services often. This study helps to understand the reasons behind repeat ED visits which should lead to prevention protocols.
Learning Objectives: 1) Understand common risk factors associated with high frequency ED utilization.
2) Describe pattern of ED revisits by patients with CSF shunts.