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Predictors of Ventricular Shunt Infection Among Children Presenting to a Pediatric Emergency Department

Rogers, Elisabeth Ashley MD*; Kimia, Amir MD; Madsen, Joseph R. MD; Nigrovic, Lise E. MD, MPH; Neuman, Mark I. MD, MPH

doi: 10.1097/PEC.0b013e318252c23c
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Objectives Among a population of children with a ventricular shunt presenting to a pediatric emergency department (ED), and in whom cerebrospinal fluid (CSF) was obtained, we sought to (1) determine the rate of positive CSF bacterial culture and (2) identify clinical predictors of ventricular shunt infection.

Methods We performed a retrospective cohort study of children 3 months to 21 years of age evaluated in a single pediatric tertiary ED from 1995 to 2008. All included children had CSF obtained within 24 hours of presentation to the ED. A shunt infection was defined by growth of bacteria in the CSF of a child who underwent shunt removal within 7 days of presentation.

Results Nine hundred seventy-nine children met the inclusion criteria; 130 patients (13%) had growth of bacteria in CSF, of which 58 (5.9% of total) had a shunt infection. The median time since last shunt revision or replacement was shorter for patients with a shunt infection compared with children without shunt infection (44 vs 209 days, P = 0.001). After adjustment for patient age, the following factors were associated with shunt infection: shunt revision within the prior 90 days (adjusted odds ratio [aOR], 2.4; 95% CI, 1.3–4.4), presence of fever (aOR, 8.4; 95% CI, 4.3–16.3), and white blood cell count greater than 15,000/μL (aOR, 3.2; 95% CI, 1.5–6.6).

Conclusions Among children with a ventricular shunt who had CSF obtained in the ED, the presence of recent shunt revision, fever, and leukocytosis was associated with ventricular shunt infection.

From the *Department of Emergency Medicine, University of Virginia, Charlottesville, VA; †Division of Emergency Medicine and ‡Department of Neurosurgery, Children’s Hospital, Boston, Harvard Medical School, Boston, MA.

Disclosure: The authors declare no conflict of interest.

Reprints: Elisabeth Ashley Rogers, MD, Department of Emergency Medicine, University of Virginia, PO Box 800699, Charlottesville, VA 22908 (e-mail: Elisabeth_rogers@bshsi.org).

The authors received no funding for this research.

© 2012 Lippincott Williams & Wilkins, Inc.