UNASSIGNED: OBJECT The rate of CSF shunt failure remains unacceptably high. The @entity1276 Clinical Research Network (HCRN) conducted a comprehensive prospective observational study of @entity1276 management, the aim of which was to isolate specific risk factors for shunt failure. METHODS The study followed all first-time shunt insertions in @entity1 younger than 19 years at 6 HCRN centers. The HCRN Investigator Committee selected, a priori, 21 variables to be examined, including clinical, radiographic, and shunt design variables. Shunt failure was defined as shunt revision, subsequent endoscopic third ventriculostomy, or @entity281 . Important a priori-defined risk factors as well as those significant in univariate analyses were then tested for independence using multivariate Cox proportional hazard modeling. RESULTS A total of 1036 @entity1 underwent initial CSF shunt placement between April 2008 and December 2011. Of these, 344 @entity1 experienced shunt failure, including 265 malfunctions and 79 @entity281 . The mean and median length of follow-up for the entire cohort was 400 days and 264 days, respectively. The Cox model found that age younger than 6 months at first shunt placement (HR 1.6 [95% CI 1.1-2.1]), a cardiac comorbidity (HR 1.4 [95% CI 1.0-2.1]), and endoscopic placement (HR 1.9 [95% CI 1.2-2.9]) were independently associated with reduced shunt survival. The following had no independent associations with shunt survival: etiology, payer, center, valve design, valve programmability, the use of ultrasound or stereotactic guidance, and surgeon experience and volume. CONCLUSIONS This is the largest prospective study reported on @entity1 with CSF shunts for @entity1276 . It confirms that a young age and the use of the endoscope are risk factors for first shunt failure and that valve type has no impact. A new risk factor-an existing cardiac comorbidity-was also associated with shunt failure.

Risk factors for shunt malfunction in pediatric XXXX : a multicenter prospective cohort study.

@entity1 :: ('9606', 'Species') :: ['children', 'patients'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infections', 'shunt infection'] @entity1276 :: ('MESH:D006849', 'Disease') :: ['hydrocephalus', 'Hydrocephalus']
@entity1276 :: (MESH:D006849,Disease) :: ['hydrocephalus']
