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 of revision and ICP monitoring versus infusion tests. RESULTS Three hundred sixty-five 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. Two hundred fifty-eight (> 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 £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.

中文翻译：

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分流输注研究：对患者结果的影响，包括健康经济学。

目的分流器故障的诊断通常并不简单。我们已经研究了在有症状的脑积水或假性脑小脑综合征（PTCS）的分流患者中，CSF输液测试在将功能性分流器与可能存在问题的分流器区分开的准确性以及对健康的经济影响。方法研究对象：2013年1月至2015年12月进行脑积水/ PTCS输液测试的患者。我们在测试后6个月和12个月对患者进行了随访，以确定他们是否有所改善，症状持续或需要紧急修订。我们计算了修订版与输液测试的总成本节省，以及修订版和ICP监控与输液测试的标准协议。结果在存在分流前室/水库的地方进行了365次分流输液测试。对于脑积水患者，超过一半的测试（〜55％，280例中的155例）无分流故障，而有125例有可能出现故障（年龄从4个月到90岁）。对于10到77岁的PTCS患者，有47个可能出现问题，而38个没有分流器故障的征兆。总体而言，三年内避免了290多次不必要的修订。非手术治疗者中有258例（> 85％）保持良好，没有恶化并且不需要手术。没有感染与输注研究有关。对于剑桥而言，每年避免修订的总节省为945,415英镑。结论我们的结果提供了在体内进行分流测试以确认分流器故障的重要性的证据。避免不必要的分流翻修会为患者带来巨大的健康收益，也将为国家卫生服务局以及全球其他医疗系统带来可观的经济收益。