{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T11:43:51Z","timestamp":1792755831327,"version":"4.5.0"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Patients with shunts often interact with providers distant from their primary hospital, making it important that the parent(s)\/guardian(s) is well versed in the type of shunt implanted and symptoms of malfunction\/infection. This is particularly important with magnetic-sensitive programmable valves, as the use of MRI becomes more prevalent.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Over a 6-month period, primary caregivers of 148 consecutive patients who received shunts were prospectively administered questionnaires at clinic visits. Caregivers were asked to do the following: 1) identify shunt valve name, type, and setting if applicable; 2) list symptoms of shunt malfunction\/infection; and 3) indicate whether they had access to references regarding shunt type\/setting, booklets from the Hydrocephalus Association, and quick reference cards with symptoms of shunt malfunction\/infection. One cohort of caregivers (n = 75) was asked to carry informational cards with shunt valve\/setting information (group I); this cohort was compared with another subgroup of caregivers (n = 73) not carrying cards (group II).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The mean (\u00b1 SD) age of patients at implantation\/revision was 3.71 \u00b1 4.91 years, and the age at follow-up was 6.12 \u00b1 5.4 years. The average time from surgery to administration of the questionnaire was 2.38 \u00b1 3.22 years. There were 86 new shunt insertions and 62 revisions. One hundred twenty-eight caregivers (87%) could identify the type of valve (programmable vs nonprogrammable). On the other hand, only 72 caregivers (49%) could identify the valve name. Fifty-four of 73 (74%) caregivers of patients who had shunts with programmable valves could correctly identify the valve setting. One hundred caregivers (68%) had a copy of the Hydrocephalus Association booklet, and 103 (70%) had quick reference cards. Eighty caregivers (54%) had references on shunt type\/setting. Most caregivers (127 [86%]) could name \u2265 3 signs\/symptoms of shunt malfunction, with vomiting (61%), headache (49%), and sleeps more\/lethargic (35%) most frequently reported. Caregivers of patients in group I were more likely to have cards with symptoms of shunt infection or malfunction (p = 0.015); have information cards regarding shunt type\/setting (p &lt; 0.001); and correctly identify valve type (p = 0.001), name (p &lt; 0.001), and setting if programmable (p = 0.0016). There were no differences in ability to list symptoms of shunt malfunction or infection (p = 0.8812) or in access to Hydrocephalus Association booklets (p = 0.1288). There were no significant demographic differences between the groups, except that group I patients had a shorter time from surgery to last follow-up (1.66 vs 3.17 years; p = 0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Education regarding the care of patients with shunts by providing written cards with shunt type\/setting and access to reference materials seems to be effective. Developing plans for guided instruction with assessment in the clinic setting of a caregiver\u2019s knowledge is important for patient safety.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.9.peds17253","type":"journal-article","created":{"date-parts":[[2018,1,12]],"date-time":"2018-01-12T14:55:32Z","timestamp":1515768932000},"page":"359-366","source":"Crossref","is-referenced-by-count":16,"title":["Parent\/guardian knowledge regarding implanted shunt type, setting, and symptoms of malfunction\/infection"],"prefix":"10.3171","volume":"21","author":[{"given":"Laurie L.","family":"Ackerman","sequence":"first","affiliation":[{"name":"Goodman Campbell Brain and Spine and"},{"name":"Division of Pediatric Neurosurgery, Department of Neurological Surgery, Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Fulkerson","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine and"},{"name":"Division of Pediatric Neurosurgery, Department of Neurological Surgery, Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Jea","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine and"},{"name":"Division of Pediatric Neurosurgery, Department of Neurological Surgery, Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jodi L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine and"},{"name":"Division of Pediatric Neurosurgery, Department of Neurological Surgery, Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1007\/s00381-007-0408-4","article-title":"Death in shunted hydrocephalic children: a follow-up study","volume":"24","author":"Acakpo-Satchivi L","year":"2008","unstructured":"Acakpo-Satchivi L, Shannon CN, Tubbs RS, Wellons JC III, Blount JP, Iskandar BJ, : Death in shunted hydrocephalic children: a follow-up study. Childs Nerv Syst 24:197\u2013201, 20081759410210.1007\/s00381-007-0408-4"},{"key":"b2","series-title":"Arch Pediatr Adolesc Med","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1001\/archpedi.161.1.38","article-title":"Hospital volumes for common pediatric specialty operations","volume":"161","author":"Berry JG","year":"2007","unstructured":"Berry JG, Lieu TA, Forbes PW, Goldmann DA: Hospital volumes for common pediatric specialty operations. Arch Pediatr Adolesc Med 161:38\u201343, 20071719906510.1001\/archpedi.161.1.38"},{"key":"b3","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1159\/000120968","article-title":"Epidemiology of cerebrospinal fluid shunting","volume":"23","author":"Bondurant CP","year":"1995","unstructured":"Bondurant CP, Jimenez DF: Epidemiology of cerebrospinal fluid shunting. Pediatr Neurosurg 23:254\u2013259, 199510.1159\/0001209688688350"},{"key":"b4","series-title":"Pediatrics","first-page":"e47","article-title":"Comparison of rapid cranial MRI to CT for ventricular shunt malfunction","volume":"134","author":"Boyle TP","year":"2014","unstructured":"Boyle TP, Paldino MJ, Kimia AA, Fitz BM, Madsen JR, Monuteaux MC, : Comparison of rapid cranial MRI to CT for ventricular shunt malfunction. Pediatrics 134:e47\u2013e54, 2014"},{"key":"b5","series-title":"Can J Neurol Sci","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1017\/S0317167100016280","article-title":"Improving information provision for neurosurgical patients: a qualitative study","volume":"41","author":"Bramall AN","year":"2014","unstructured":"Bramall AN, Bernstein M: Improving information provision for neurosurgical patients: a qualitative study. Can J Neurol Sci 41:66\u201373, 20142438434010.1017\/S0317167100016280"},{"key":"b6","series-title":"Pediatr Neurol","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.pediatrneurol.2005.05.021","article-title":"Failure of cerebrospinal fluid shunts: part II: overdrainage, loculation, and abdominal complications","volume":"34","author":"Browd SR","year":"2006","unstructured":"Browd SR, Gottfried ON, Ragel BT, Kestle JR: Failure of cerebrospinal fluid shunts: part II: overdrainage, loculation, and abdominal complications. Pediatr Neurol 34:171\u2013176, 200610.1016\/j.pediatrneurol.2005.05.02116504785"},{"key":"b7","series-title":"Pediatr Neurol","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.pediatrneurol.2005.05.020","article-title":"Failure of cerebrospinal fluid shunts: part I: obstruction and mechanical failure","volume":"34","author":"Browd SR","year":"2006","unstructured":"Browd SR, Ragel BT, Gottfried ON, Kestle JR: Failure of cerebrospinal fluid shunts: part I: obstruction and mechanical failure. Pediatr Neurol 34:83\u201392, 200610.1016\/j.pediatrneurol.2005.05.02016458818"},{"key":"b8","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"318","DOI":"10.3171\/2010.7.PEDS09534","article-title":"Effectiveness of a clinical pathway for patients with cerebrospinal fluid shunt malfunction","volume":"6","author":"Chern JJ","year":"2010","unstructured":"Chern JJ, Macias CG, Jea A, Curry DJ, Luerssen TG, Whitehead WE: Effectiveness of a clinical pathway for patients with cerebrospinal fluid shunt malfunction. J Neurosurg Pediatr 6:318\u2013324, 201010.3171\/2010.7.PEDS0953420887102"},{"key":"b9","series-title":"J Pediatr","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1016\/j.jpeds.2015.09.024","article-title":"emergency department use of computed tomography for children with ventricular shunts","volume":"167","author":"Florin TA","year":"2015","unstructured":"Florin TA, Aronson PL, Hall M, Kharbanda AB, Shah SS, Freedman SB, : emergency department use of computed tomography for children with ventricular shunts. J Pediatr 167:1382\u20131388, 1388.e2, 201510.1016\/j.jpeds.2015.09.02426474707"},{"key":"b10","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"202","DOI":"10.3171\/jns.2001.94.2.0202","article-title":"Predicting shunt failure on the basis of clinical symptoms and signs in children","volume":"94","author":"Garton HJ","year":"2001","unstructured":"Garton HJ, Kestle JR, Drake JM: Predicting shunt failure on the basis of clinical symptoms and signs in children. J Neurosurg 94:202\u2013210, 20011121395510.3171\/jns.2001.94.2.0202"},{"key":"b11","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1159\/000028644","article-title":"Death in shunted hydrocephalic children in the 1990s","volume":"28","author":"Iskandar BJ","year":"1998","unstructured":"Iskandar BJ, Tubbs S, Mapstone TB, Grabb PA, Bartolucci AA, Oakes WJ: Death in shunted hydrocephalic children in the 1990s. Pediatr Neurosurg 28:173\u2013176, 1998973224210.1159\/000028644"},{"key":"b12","series-title":"J R Soc Med","first-page":"219","article-title":"Patients\u2019 memory for medical information","volume":"96","author":"Kessels RP","year":"2003","unstructured":"Kessels RP: Patients\u2019 memory for medical information. J R Soc Med 96:219\u2013222, 200312724430"},{"key":"b13","series-title":"Pediatr Emerg Care","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1097\/PEC.0b013e31812c65b4","article-title":"Test characteristics of parent\u2019s visual analog scale score in predicting ventriculoperitoneal shunt malfunction in the pediatric emergency department","volume":"23","author":"Kim TY","year":"2007","unstructured":"Kim TY, Brown L, Stewart GM: Test characteristics of parent\u2019s visual analog scale score in predicting ventriculoperitoneal shunt malfunction in the pediatric emergency department. Pediatr Emerg Care 23:549\u2013552, 20071772641410.1097\/PEC.0b013e31812c65b4"},{"key":"b14","series-title":"Pediatr Emerg Care","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/01.pec.0000195764.50565.8c","article-title":"Signs and symptoms of cerebrospinal fluid shunt malfunction in the pediatric emergency department","volume":"22","author":"Kim TY","year":"2006","unstructured":"Kim TY, Stewart G, Voth M, Moynihan JA, Brown L: Signs and symptoms of cerebrospinal fluid shunt malfunction in the pediatric emergency department. Pediatr Emerg Care 22:28\u201334, 200610.1097\/01.pec.0000195764.50565.8c16418609"},{"key":"b15","series-title":"Patient Educ Couns","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1016\/j.pec.2015.02.003","article-title":"Improving patient recall of information: Harnessing the power of structure","volume":"98","author":"Langewitz W","year":"2015","unstructured":"Langewitz W, Ackermann S, Heierle A, Hertwig R, Ghanim L, Bingisser R: Improving patient recall of information: Harnessing the power of structure. Patient Educ Couns 98:716\u2013721, 201510.1016\/j.pec.2015.02.00325770048"},{"key":"b16","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"222","DOI":"10.3171\/PED\/2008\/2\/9\/222","article-title":"Magnetic field interactions in adjustable hydrocephalus shunts","volume":"2","author":"Lavinio A","year":"2008","unstructured":"Lavinio A, Harding S, Van Der Boogaard F, Czosnyka M, Smielewski P, Richards HK, : Magnetic field interactions in adjustable hydrocephalus shunts. J Neurosurg Pediatr 2:222\u2013228, 200810.3171\/PED\/2008\/2\/9\/22218759607"},{"key":"b17","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.3174\/ajnr.A1997","article-title":"Programmable CSF shunt valves: radiographic identification and interpretation","volume":"31","author":"Lollis SS","year":"2010","unstructured":"Lollis SS, Mamourian AC, Vaccaro TJ, Duhaime AC: Programmable CSF shunt valves: radiographic identification and interpretation. AJNR Am J Neuroradiol 31:1343\u20131346, 20102015031310.3174\/ajnr.A1997"},{"key":"b18","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"363","DOI":"10.3171\/2011.12.PEDS11291","article-title":"Parental recognition of shunt failure: a prospective single-institution study","volume":"9","author":"Naftel RP","year":"2012","unstructured":"Naftel RP, Tubergen E, Shannon CN, Gran KA, Vance EH, Oakes WJ, : Parental recognition of shunt failure: a prospective single-institution study. J Neurosurg Pediatr 9:363\u2013371, 201210.3171\/2011.12.PEDS1129122462699"},{"key":"b19","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1007\/s00381-007-0560-x","article-title":"Cumulative diagnostic radiation exposure in children with ventriculoperitoneal shunts: a review","volume":"24","author":"Smyth MD","year":"2008","unstructured":"Smyth MD, Narayan P, Tubbs RS, Leonard JR, Park TS, Loukas M, : Cumulative diagnostic radiation exposure in children with ventriculoperitoneal shunts: a review. Childs Nerv Syst 24:493\u2013497, 200810.1007\/s00381-007-0560-x18180935"},{"key":"b20","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1007\/BF00302769","article-title":"The diagnosis of blocked cerebrospinal fluid shunts: a prospective study of referral to a paediatric neurosurgical unit","volume":"10","author":"Watkins L","year":"1994","unstructured":"Watkins L, Hayward R, Andar U, Harkness W: The diagnosis of blocked cerebrospinal fluid shunts: a prospective study of referral to a paediatric neurosurgical unit. Childs Nerv Syst 10:87\u201390, 199410.1007\/BF00302769"},{"key":"b21","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"514","DOI":"10.3171\/2014.2.PEDS12508","article-title":"Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up","volume":"13","author":"White IK","year":"2014","unstructured":"White IK, Shaikh KA, Moore RJ, Bullis CL, Sami MT, Gianaris TJ, : Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up. J Neurosurg Pediatr 13:514\u2013519, 20142462850910.3171\/2014.2.PEDS12508"},{"key":"b22","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"420","DOI":"10.3171\/2014.9.PEDS14207","article-title":"Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation","volume":"15","author":"Yue EL","year":"2015","unstructured":"Yue EL, Meckler GD, Fleischman RJ, Selden NR, Bardo DM, Chu O\u2019Connor AK, : Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation. J Neurosurg Pediatr 15:420\u2013426, 201510.3171\/2014.9.PEDS1420725634816"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/21\/4\/article-p359.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/21\/4\/article-p359.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/21\/4\/article-p359.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:47:26Z","timestamp":1681566446000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/21\/4\/article-p359.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4]]},"references-count":22,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2017.9.peds17253","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4]]}}}