Ventricular Shunt Obstruction/Infection — Disposition — Clinical Pathway: Emergency, ICU and Inpatient

Ventricular Shunt Obstruction/Infection Clinical Pathway — Emergency, ICU and Inpatient

Disposition

Discharge Criteria
  • Evaluation not concerning for shunt malfunction or infection
  • Adequate relief from presenting symptoms, tolerating PO
  • High/Moderate risk patients:
    • Neurosurgery agrees with the plan for discharge
  • Follow-up:
    • High/Moderate risk: 1-2 days with PCP and within 1-2 weeks with Neurosurgery
    • Low risk: 2-3 days with PCP and 1-2 weeks or as needed with Neurosurgery
    Admission Criteria
    • General Pediatrics/Adolescent Medicine
      • Shunt malfunction or infection highly unlikely
      • If last revision < 3 months - alternative source of fever identified and/or CSF studies are reassuring
      • No bradycardia (including intermittent or relative to disease state) or other hemodynamic instability
      • Baseline mental status
      • Neurosurgical evaluation is completed
      • VS, q 4 hour neuro check are assured on all patients
    • PICU
      • Altered mental status
      • Shunt malfunction or infection
      • Intermittent or persistent bradycardia
      • Hemodynamic instability