False alarms and the burden of shunt failure in pediatric patients with hydrocephalus: a longitudinal study

Objective: This study aimed to investigate the burden of CSF shunt failure and false alarms on pediatric patients with hydrocephalus, their caregivers, and the healthcare system.

Methods: This retrospective longitudinal study examined pediatric patients who underwent CSF shunt procedures at Auckland City Hospital from January 2014 to December 2019. The study included patients aged 18 years or younger living within the hospital's catchment area. Clinical encounters were recorded from the date of their first shunt insertion until November 1, 2023. Data collected included patient demographics, hospital admissions, acute and elective shunt-related imaging, clinic visits, surgery times, and symptom characteristics. Shunt-related admissions were categorized as either shunt failures or false alarms.

Results: The cohort comprised 73 patients with follow-up periods ranging from 4 to 18 years. By the 1st year, 71% had been rehospitalized for shunt-related concerns, with 59% experiencing at least 1 false alarm and 38% experiencing at least 1 shunt failure. By the 4th year, 88% of patients had been rehospitalized for shunt-related concerns, 42% had experienced at least 3 false alarms, 60% had at least 1 shunt failure, and 25% had at least 3 shunt failures. The average accumulated hospital stay was 1 month for shunt failures and 2 weeks for false alarms, compared with 22 days for all other admissions. Frequent clinic interactions from multiple specialties highlighted the complex care needs of these patients. The timing of shunt failure or false alarm, but not symptom duration, significantly predicted their overall frequency.

Conclusions: This study details the chronic burden and complex care requirements for pediatric patients with CSF shunts. Shunt-related concerns significantly and disproportionately contribute to the patients' total hospital interactions. The findings highlight the immediate clinical need for novel technologies to enable long-term and accurate detection of shunt failure to optimize patient care. Future efforts should focus on improving shunt systems to lower failure rates.