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You are the speciality trainee working in a district general hospital Emergency Department (ED). A 4-year-old boy is presented to the ED by his parents following a 48-hour history of progressive headache and vomiting with lethargy and irritability. His parents report that he was born prematurely and has had a ventriculoperitoneal (VP) shunt inserted. He has otherwise been well for the past few weeks and there are no signs or symptoms of infection.
You want to obtain head CT imaging before discussing with the neurosurgical team but note that he has had numerous previous ED attendances with several radiographic and head CT examinations. You do not want to expose the child to unnecessary ionising radiation. Is a radiographic shunt series (SS) necessary if a head CT is going to be performed?
Structured clinical question
Do children with suspected shunt failure (patient) also require a radiographic SS (outcome) if a head CT is going to be, or has been, performed (intervention)?
PubMed and MEDLINE databases on NHS Evidence were searched for eligible articles published in English from January 1980 to May 2020. The following search terms were used: (child* OR paediatric OR pediatric) AND (((acute AND failure) OR block*) AND ((ventriculoperitoneal OR VP OR V-P OR cerebral) AND shunt) OR hydrocephalus) AND (computed tomography OR CT OR computed assisted tomography OR CAT) AND ((radiograph* OR (x-ray …
Contributors Guarantor of integrity of the entire study, study concepts and design, literature research: MP. Clinical studies and statistical analysis: not applicable. Experimental studies/data analysis and manuscript preparation: GB and MP. Manuscript editing: GB, SS, SM, DJAC and MP.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.