{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:57:32Z","timestamp":1786125452834,"version":"build-2736575974"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2020,5,27]],"date-time":"2020-05-27T00:00:00Z","timestamp":1590537600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/ mailto:journals.permissions@oup.com"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Thermal flow evaluation (TFE) is a non-invasive method to assess ventriculoperitoneal shunt function. Flow detected by TFE is a negative predictor of the need for revision surgery. Further optimization of testing protocols, evaluation in multiple centers, and integration with clinical and imaging impressions prompted the current study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To compare the diagnostic accuracy of 2 TFE protocols, with micropumper (TFE+MP) or without (TFE-only), to neuro-imaging in patients emergently presenting with symptoms concerning for shunt malfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We performed a prospective multicenter operator-blinded trial of a consecutive series of patients who underwent evaluation for shunt malfunction. TFE was performed, and preimaging clinician impressions and imaging results were recorded. The primary outcome was shunt obstruction requiring neurosurgical revision within 7 d. Non-inferiority of the sensitivity of TFE vs neuro-imaging for detecting shunt obstruction was tested using a prospectively determined a priori margin of \u22122.5%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>We enrolled 406 patients at 10 centers. Of these, 68\/348 (20%) evaluated with TFE+MP and 30\/215 (14%) with TFE-only had shunt obstruction. The sensitivity for detecting obstruction was 100% (95% CI: 88%-100%) for TFE-only, 90% (95% CI: 80%-96%) for TFE+MP, 76% (95% CI: 65%-86%) for imaging in TFE+MP cohort, and 77% (95% CI: 58%-90%) for imaging in the TFE-only cohort. Difference in sensitivities between TFE methods and imaging did not exceed the non-inferiority margin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>TFE is non-inferior to imaging in ruling out shunt malfunction and may help avoid imaging and other steps. For this purpose, TFE only is favored over TFE+MP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyaa128","type":"journal-article","created":{"date-parts":[[2020,4,3]],"date-time":"2020-04-03T00:05:42Z","timestamp":1585872342000},"page":"939-948","source":"Crossref","is-referenced-by-count":6,"title":["Diagnostic Accuracy of Non-Invasive Thermal Evaluation of Ventriculoperitoneal Shunt Flow in Shunt Malfunction: A Prospective, Multi-Site, Operator-Blinded Study"],"prefix":"10.1227","volume":"87","author":[{"given":"Joseph R","family":"Madsen","sequence":"first","affiliation":[{"name":"Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tehnaz P","family":"Boyle","sequence":"additional","affiliation":[{"name":"Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts"},{"name":"Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark I","family":"Neuman","sequence":"additional","affiliation":[{"name":"Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Hyoung","family":"Park","sequence":"additional","affiliation":[{"name":"Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep S","family":"Tamber","sequence":"additional","affiliation":[{"name":"Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"},{"name":"British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W","family":"Hickey","sequence":"additional","affiliation":[{"name":"Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory G","family":"Heuer","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph J","family":"Zorc","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey R","family":"Leonard","sequence":"additional","affiliation":[{"name":"Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie C","family":"Leonard","sequence":"additional","affiliation":[{"name":"Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Keating","sequence":"additional","affiliation":[{"name":"Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M","family":"Chamberlain","sequence":"additional","affiliation":[{"name":"Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M","family":"Frim","sequence":"additional","affiliation":[{"name":"The University of Chicago Comer Children's Hospital, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Zakrzewski","sequence":"additional","affiliation":[{"name":"The University of Chicago Comer Children's Hospital, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Klinge","sequence":"additional","affiliation":[{"name":"Rhode Island Hospital, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa H","family":"Merck","sequence":"additional","affiliation":[{"name":"Rhode Island Hospital, Brown University, Providence, Rhode Island"},{"name":"University of Florida College of Medicine, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Piatt","sequence":"additional","affiliation":[{"name":"Alfred I. 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