1224 Signs & Symptoms Predictive of CSF Shunt Dysfunction in Children & Young People Presenting to ED

Aim To investigate signs and symptoms in children and young people (CYP), with cerebrospinal fluid (CSF) shunts, presenting to a CYP emergency department (ED) with onsite paediatric neurosurgical facilities; and assess their association with 30-day shunt revision rate. Method Retrospective analysis of CYP (<17 years old) with CSF shunts presenting to the CYP ED. Univariate and multivariate analyses were performed to assess the relationship between patient characteristics, presenting signs and symptoms, and 30-day shunt revision rate. Results We analysed 107 presentations between 03/11/2021 and 25/10/2022. 42% of patients were female with a mean age of 5.64 years. The most common shunt aetiologies included tumour (30%) and intraventricular haemorrhage (30%). Vomiting (37%), reduced alertness (27%), and behaviour change (27%) were the most common symptoms. 13% of patients underwent shunt revision within 30 days of presentation. No individual sign or symptom was highly sensitive, with the most sensitive being headache (64%) and vomiting (64%). Univariate analysis demonstrated that ≥2 (two or more) previous shunt revisions, fever, pallor, headache, and surgical site swelling, were significantly more common in those who underwent shunt revision (p<0.05). However, only headache and shunt site swelling were independently predictive using multivariate analysis (p<0.05). Conclusions CYP with CSF shunts present with complex symptomatology. Number of shunt revisions, headache, and shunt site swelling were predictive of shunt revision at 30 days. Understanding and integrating key predictors of CSF shunt failure into the diagnostic pathway is essential for improving efficiency and minimising the impact on CYP and their families.