Abstract
Purpose
Shunt pumping test has often been used clinically to detect functional status of ventriculoperitoneal (VP) shunt. Its ability to correctly predict the status is not reliably known. Ethical dilemmas make it difficult to perform any studies in patients with blocked shunts, and hence, a requirement of devising an experimental model was felt.
Method
An experimental model was devised using a Chhabra Slit N Spring shunt. The pressures were maintained in the proximal and distal chamber by real-time monitoring and maintained similar to intra-ventricular and intra-abdominal pressures. Three such models with scenarios of proximal block (PB), distal block (DB), and a functional shunt (BO) were created. Twenty-five participants were tested using these models to assess the efficacy of shunt pumping test.
Results
The experimental model could be used successfully to perform the test. The sensitivity of the test to detect a shunt with block on any side (AB) was found to be 0.79 (95% confidence interval 0.72–0.85) and specificity to be 0.69 (95% confidence interval 0.59–0.80). Its ability to detect the side of block was also evaluated. Absolute correctness value, odds ratio, and interpersonal heterogeneity were also evaluated. Pressure changes in proximal and distal catheter on compressing the chamber in various scenarios were recorded.
Conclusion
The shunt pumping test has moderate ability to predict a blocked shunt and can aid clinical assessment of shunt block. It has only limited ability to detect the side of block. Pressure changes in the proximal and distal catheters on chamber compression are commensurate with the rationale of “shunt pumping test.”
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Data availability
Raw data are available.
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Authors and Affiliations
Contributions
Dr. Manish Sharma: conceptualisation, model preparation, conduct of study, and manuscript writing.
Dr. Karthik Rammohan: conduct of study and manuscript writing.
Dr. Suman Kumar: statistical analysis, critical evaluation, and supervision of conduct of study.
Dr. Krishna Kumar M: conduct of study.
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Disclaimer
The study was performed using Chhbra Slit n Spring Shunt System and the results are considered relevant only for this brand. Its reproducibility on other commercial brands will have to be tested separately.
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Sharma, M., Mohan, K.R., Kumar, S. et al. “Shunt pumping test”: detecting its efficacy through an experimental model. Childs Nerv Syst 37, 1597–1604 (2021). https://doi.org/10.1007/s00381-020-04998-5
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DOI: https://doi.org/10.1007/s00381-020-04998-5