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dc.contributor.authorLalou, Despoinaen
dc.contributor.authorCzosnyka, Mareken
dc.contributor.authorGarnett, Matthew Ren
dc.contributor.authorNabbanja, Evaen
dc.contributor.authorPetrella, Gianpaoloen
dc.contributor.authorHutchinson, Peteren
dc.contributor.authorPickard, John Den
dc.contributor.authorCzosnyka, Zofiaen
dc.date.accessioned2020-02-04T00:30:46Z
dc.date.available2020-02-04T00:30:46Z
dc.date.issued2020-05en
dc.identifier.issn0001-6268
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/301669
dc.description.abstractAbstract Objectives: The diagnosis of shunt malfunction is often not straightforward. We have explored, in symptomatic shunted patients with hydrocephalus or pseudotumour cerebri syndrome (PTCS), the accuracy of CSF infusion tests in differentiating a functioning shunt from one with possible problems, and the health economic consequences. Methods: Participants: hydrocephalus/PTCS patients with infusion tests performed from January 2013 until December 2015. We followed patients up after 6 and 12 months from the test to determine whether they had improved, had persisting symptoms or had required urgent revision. We calculated the total cost savings of revision versus infusion tests and standard protocol with ICP monitoring versus infusion tests. Results: 365 shunt infusion tests had been performed where a shunt prechamber/reservoir was present: For hydrocephalus patients, more than half of the tests (~55%, 155 out of 280) showed no shunt malfunction versus 125 with possible malfunction (ages 4 months to 90 years old). For PTCS patients aged 10 to 77 years old, 47 had possible problems and 38 no indication for shunt malfunction. Overall, >290 unnecessary revisions were avoided over 3 years’ time. 258 (>85%) of those non-surgically managed, remained well, did not deteriorate and did not require surgery. No infections were associated with infusion studies. For Cambridge, the overall savings from avoiding revisions was around £945,415 annually. Conclusions: Our results provide evidence of the importance of shunt testing in vivo to confirm shunt malfunction. Avoiding unnecessary shunt revisions carries a strong health benefit for patients that also translates to a significant financial benefit for the National Health Service and potentially for other healthcare systems worldwide.
dc.description.sponsorshipNil
dc.format.mediumPrint-Electronicen
dc.languageengen
dc.publisherSpringer Nature
dc.rightsAll rights reserved
dc.subjectHumansen
dc.subjectHydrocephalusen
dc.subjectPseudotumor Cerebrien
dc.subjectCerebrospinal Fluid Shuntsen
dc.subjectRetrospective Studiesen
dc.subjectAge Factorsen
dc.subjectIntracranial Pressureen
dc.subjectAdolescenten
dc.subjectAdulten
dc.subjectAgeden
dc.subjectAged, 80 and overen
dc.subjectMiddle Ageden
dc.subjectChilden
dc.subjectChild, Preschoolen
dc.subjectInfanten
dc.subjectState Medicineen
dc.subjectFemaleen
dc.subjectMaleen
dc.subjectYoung Adulten
dc.titleShunt infusion studies: impact on patient outcome, including health economics.en
dc.typeArticle
prism.endingPage1031
prism.issueIdentifier5en
prism.publicationDate2020en
prism.publicationNameActa neurochirurgicaen
prism.startingPage1019
prism.volume162en
dc.identifier.doi10.17863/CAM.48740
dcterms.dateAccepted2020-01-06en
rioxxterms.versionofrecord10.1007/s00701-020-04212-0en
rioxxterms.versionAM
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2020-05en
dc.contributor.orcidLalou, Despoina [0000-0003-3768-8681]
dc.contributor.orcidHutchinson, Peter [0000-0002-2796-1835]
dc.identifier.eissn0942-0940
rioxxterms.typeJournal Article/Reviewen
cam.orpheus.successTue Mar 31 10:37:28 BST 2020 - Embargo updated*
rioxxterms.freetoread.startdate2021-02-20


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