Do Children With Suspected Shunt Failure Also Require A Radiographic Shunt Series If Head Ct Is Going To Be, Or Has Been, Performed?

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.\n\nYou 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?\n\nDo 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)?\n\nPubMed 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 OR …