Bradycardia Without Hypertension: Is It a Common Clinical Presentation of Ventriculoperitoneal Shunt Malfunction in Pediatric Patients?

BACKGROUND: Mechanical shunting of cerebrospinal fluid is an effective treatment for hydrocephalus. Some studies suggest that bradycardia without hypertension may also be observed in ventriculoperitoneal (VP) shunt malfunction; however, in our experience, this is not a common presenting sign. OBJECTIVE: The aim of this study was to evaluate whether bradycardia without hypertension was a common sign in patients presenting to the pediatric emergency department (ED) with a VP shunt malfunction. METHODS: A retrospective observational study, from May 2006 to April 2015, which included a random sample of children admitted to the ED with clinical features suggestive of possible VP shunt malfunction. Control patients were defined as those who arrived at our ED with suspected VP shunt malfunction that was later ruled out on further workup. RESULTS: A total of 65 patients were included in this study. A significantly greater number of patients with a confirmed shunt pathology presented with vomiting (P = 0.01) and lethargy/apathy (P = 0.01). In the control group, a significantly greater number of patients presented with fever (P = 0.004) and seizures (P = 0.02). The number of patients presenting with bradycardia was not significantly different between the shunt pathology and control groups (P > 0.05). CONCLUSIONS: Bradycardia is not a common presentation in patients with VP shunt malfunction. Bradycardia is often recognized as a significant sign; however, it is one of the last presenting signs. Educating patients about the early signs must be considered as part of the treatment for VP shunt malfunction.

Publication outcomes of abstracts presented at an international toxicology conference.

INTRODUCTION: The timely and formal publication of material presented at national and international meetings is critical to the dissemination of new information to the medical community. The conversion rates for toxicology abstracts to full-text publications at previous North American toxicology meetings were low. No study has assessed the publication rate from the European Association of Poisons Centers and Clinical Toxicologists (EAPCCT). METHODS: We reviewed 269 abstracts presented at the 2013 EAPCCTcongress. We searched the PubMed, EMBASE, and Medline databases using the first, second, and last authors' names and keywords, through November 2018. RESULTS: Forty-seven of 269 abstracts (17%) subsequently appeared in 29 different peer-reviewed journals, led by Clinical Toxicology (13 out of 47, 28%). Leading countries of origin were the USA (8), UK (7) and Italy (6). The proportions of publications from native English-speaking and non-native English-speaking countries were similarly low (16% vs. 19%). CONCLUSIONS: Fewer than one in six abstracts reached publication within five years of the 2013 EAPCCT meeting. This rate is lower than in other specialty medical societies.