Predictors of admission and shunt revision during emergency department visits for shunt-treated adult patients with idiopathic intracranial hypertension

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OBJECTIVE

Factors associated with emergency department admission and/or shunt revision for idiopathic intracranial hypertension (IIH) are unclear. In this study, the associations of several factors with emergency department admission and shunt revision for IIH were explored.

METHODS

The authors performed a retrospective review of 31 patients (169 total emergency department visits) who presented to the emergency department for IIH-related symptoms between 2003 and 2015. Demographics, comorbidities, symptoms, IIH diagnosis and treatment history, ophthalmological examination, diagnostic lumbar puncture (LP), imaging findings, and data regarding admission and management decisions were collected. Multivariable general linear models regression analysis was performed to assess the predictive factors associated with admission and shunt revision.

RESULTS

Thirty-one adult patients with a history of shunt placement for IIH visited the emergency department a total of 169 times for IIH-related symptoms, with a median of 3 visits (interquartile range 2–7 visits) per patient. Five patients had more than 10 emergency department visits. Baseline factors associated with admission included male sex (OR 10.47, 95% CI 2.13–51.56; p = 0.004) and performance of an LP (OR 3.10, 95% CI 1.31–7.31; p = 0.01). Contrastingly, older age at presentation (OR 0.94, 95% CI 0.90–0.99; p = 0.01), and a greater number of prior emergency department visits (OR 0.94, 95% CI 0.89–0.99; p = 0.02) were slightly protective against admission. The presence of papilledema (OR 11.62, 95% CI 3.20–42.16; p < 0.001), Caucasian race (OR 40.53, 95% CI 2.49–660.09 p = 0.009), and systemic hypertension (OR 7.73, 95% CI 1.11–53.62; p = 0.03) were independent risk factors for shunt revision. In addition, a greater number of prior emergency department visits (OR 0.86, 95% CI 0.77–0.96; p = 0.009) and older age at presentation (OR 0.93, 95% CI 0.87–0.99; p = 0.02) were slightly protective against shunt revision, while there was suggestive evidence that presence of a programmable shunt (OR 0.23, 95% CI 0.05–1.14; p = 0.07) was a protective factor against shunt revision. Of note, location of the proximal catheter in the ventricle or lumbar subarachnoid space was not significantly associated with admission or shunt revision in the multivariable analyses.

CONCLUSIONS

The decision to admit a shunt-treated patient from the emergency department for symptoms related to IIH is challenging. Knowledge of factors associated with the need for admission and/or shunt revision is required. In this study, factors such as male sex, younger age at presentation, lower number of prior emergency department visits, and performance of a diagnostic LP were independent predictors of admission. In addition, papilledema was strongly predictive of the need for shunt revision, highlighting the importance of an ophthalmological examination for shunt-treated adults with IIH who present to the emergency department.

ABBREVIATIONS BMI = body mass index; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension; IQR = interquartile range; LP = lumbar puncture.
Article Information

Contributor Notes

Correspondence Benjamin Elder, Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St., Rm. 6007, Baltimore, MD 21287. email: belder4@jhmi.edu.INCLUDE WHEN CITING Published online September 23, 2016; DOI: 10.3171/2016.5.JNS151303.

Drs. Sankey and Elder contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Andrews LELiu GTKo MW: Idiopathic intracranial hypertension and obesity. Horm Res Paediatr 81:2172252014

  • 2

    Ball AKClarke CE: Idiopathic intracranial hypertension. Lancet Neurol 5:4334422006

  • 3

    Ball AKHowman AWheatley KBurdon MAMatthews TJacks AS: A randomised controlled trial of treatment for idiopathic intracranial hypertension. J Neurol 258:8748812011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Bruce BBKedar SVan Stavern GPMonaghan DAcierno MDBraswell RA: Idiopathic intracranial hypertension in men. Neurology 72:3043092009

  • 5

    Bruce BBPreechawat PNewman NJLynn MJBiousse V: Racial differences in idiopathic intracranial hypertension. Neurology 70:8618672008

  • 6

    Dandy WE: Intracranial pressure without brain tumor: diagnosis and treatment. Ann Surg 106:4925131937

  • 7

    Digre KBCorbett JJ: Pseudotumor cerebri in men. Arch Neurol 45:8668721988

  • 8

    Elder BDSankey EWGoodwin CRJusué-Torres IKhattab MHRigamonti D: Outcomes and experience with lumbopleural shunts in the management of idiopathic intracranial hypertension. World Neurosurg 84:3143192015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Friedman DIJacobson DM: Diagnostic criteria for idiopathic intracranial hypertension. Neurology 59:149214952002

  • 10

    Friesner DRosenman RLobb BMTanne E: Idiopathic intracranial hypertension in the USA: the role of obesity in establishing prevalence and healthcare costs. Obes Rev 12:e372e3802011

    • Search Google Scholar
    • Export Citation
  • 11

    Hamdallah INShamseddeen HNGetty JLSmith WAli MR: Greater than expected prevalence of pseudotumor cerebri: a prospective study. Surg Obes Relat Dis 9:77822013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Jones JSNevai JFreeman MPMcNinch DE: Emergency department presentation of idiopathic intracranial hypertension. Am J Emerg Med 17:5175211999

  • 13

    Koerner JCFriedman DI: Inpatient and emergency service utilization in patients with idiopathic intracranial hypertension. J Neuroophthalmol 34:2292322014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Liu AElder BDSankey EWGoodwin CRJusué-Torres IRigamonti D: Are shunt series and shunt patency studies useful in patients with shunted idiopathic intracranial hypertension in the emergency department?. Clin Neurol Neurosurg 138:89932015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Liu AElder BDSankey EWGoodwin CRJusué-Torres IRigamonti D: The utility of computed tomography in shunted patients with idiopathic intracranial hypertension presenting to the emergency department. World Neurosurg 84:185218562015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Raoof NSharrack BPepper IMHickman SJ: The incidence and prevalence of idiopathic intracranial hypertension in Sheffield, UK. Eur J Neurol 18:126612682011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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