Introduction: Currently, no evidence-based guidelines exist to evaluate a pediatric patient with a ventricular system shunt (atrial, peritoneal, pleural) for ventricular shunt infection, in the setting of an isolated fever. In part, this is due to a lack of data on the outcomes of accessing shunt reservoirs. This study aims to review outcomes of tapping ventricular shunts in pediatric patients for the primary indication of an isolated fever, and examine the effect of recent shunt revision on the likelihood of shunt infection in a pediatric population.
Methods: This study retrospectively reviews all procedural ventricular shunt reservoir taps from 2008 to 2018, for the indication of isolated fever (T >38.5 °C) in pediatric patients aged 0-18y/o within the UNC Hospital system. Ventricular shunt infection was defined by positive CSF cultures. Recent shunt revision was defined as < 6 months from presentation with fever.
Results: From 2008 to 2015, 24 pediatric patients underwent procedural ventricular shunt reservoir access for the indication of isolated fever. The study population included 14 males and 10 females. Of these patients, 25% had positive CSF cultures indicating ventricular shunt infections. Frequency of shunt infection increased to 42.9% when patients presented after recent shunt revision (14 of 24). No ventricular shunt infections were discovered in the 10 patients presenting with fever, but without recent shunt revision.
Conclusions: This clinical review indicates a low probability of ventricular shunt infection in pediatric patients who undergo shunt tapping for the indication of isolated fever, if there was no history of recent shunt revision. Conversely, history of recent shunt revision dramatically increases risk of infection in this population.
Patient Care: Our clinical review provides insight into outcomes of tapping ventricular shunt systems in the setting of isolated fever and provides necessary data to direct development of guidelines for evaluating the pediatric patient population.
Learning Objectives: 1) To review clinical outcomes in pediatric patients who undergo ventricular shunt reservoir access for the indication of isolated fever.
2) To assess the impact of recent shunt revision on likelihood of a ventricular shunt infection.
3) To evaluate a statistical likelihood of infection when presenting with isolated fever.